Trapped in America's Safety Net

Some groups are exempted from the individual mandate to have insurance: those whose incomes fall below the tax-filing threshold; Native Americans; incarcerated individuals; and those with financial hardship. Illegal immigrants are both exempted from the mandate and prohibited from buying insurance on an exchange, even with their own money. Most significantly, millions more will receive no assistance for health insurance coverage, as they are ineligible for either Medicaid or subsidies to buy private insurance on the exchanges. The Supreme Court ruled in June 2012 that the Medicaid expansion is optional for states, and as a result about half the states—home to more than half the nation’s uninsured—initially announced they would not broaden Medicaid eligibility.