This Article explores the less-discussed consequences to Exchanges in non-Expansion states. One consequence is that the rules designed to help individuals who fall on hard time maintain coverage can work against the poor in non-Expansion states. In those states, common life events, marriage, divorce, a new child, a job loss, and retirement, can push lower income enrollees out of subsidy eligibility. And if enrollees report income changes to the Exchange — as most Exchanges require — they’ll lose their subsidies. But in non-Expansion states, enrollees may be better off not notifying Exchanges of certain income drops.
J. Angelo DeSantis, The Thin Red Federal Poverty Line: How Rejecting the Medicaid Expansion Affects Those with Exchange Coverage, 47 J. Marshall L. Rev. 923 (2014)