Birmingham’s Ernest Maiden can’t afford health insurance, but it wasn’t supposed to be that way. The Wall Street Journal told Maiden’s story last month to illustrate what the paper called the “health-law coverage gap.”

Obamacare was supposed to make health insurance affordable for every American. Coverage would be provided in one of three ways, depending on a person’s circumstances. Here’s how it was supposed to work:

Most of us would continue to get health insurance through our employers.

People without employer-provided health insurance but with incomes up to four times the federal poverty line ($46,680 for a single person, more for families) could apply for a government subsidy to help them buy insurance on their own. The amount of the subsidy would depend on a person’s income.

And finally, instead of a subsidy, the very poor, with incomes below the federal poverty line ($11,670 for a single person, more for families) would be covered by expanding Medicaid, the federal-state program providing health care to the poor and disabled.

The Supreme Court upheld most of Obamacare in June 2012, but said that Congress had exceeded its constitutional authority by requiring every state to expand its Medicaid program. States can decide for themselves whether to expand Medicaid, the court said.

That ruling sparked a political firestorm. Expanding Medicaid would benefit needy people, but it would cost money, requiring increased taxes or a diversion of funds from other programs. Governors, legislatures, and everybody else started weighing in with their opinions.

In the end, 26 states expanded their Medicaid coverage, as intended by the original Obamacare law, and 24, including Alabama, did not.

Medicaid eligibility, whether expanded or not, is a complicated thing. Each state sets its own eligibility rules. Eligibility depends on one’s age, sex, marital status, disability, income and other such things.

When all that is factored in, Alabama’s Medicaid eligibility law ranks us 50th among the states. That means some people who would qualify for Medicaid in every other state would not qualify here. The take-home lesson from this: Don’t be poor in Alabama!

Ernest Maiden has a job, as a hair stylist at the Happiness and Hair Beauty and Barber Salon in Birmingham. He earns $10,400 per year. Under the original Obamacare law, Alabama’s Medicaid eligibility would have been required to meet minimal nationwide standards and Maiden would have been covered. But he was left out in the cold when the Supreme Court said each state could say yes or no to Medicaid expansion, and Alabama said no. That’s what socked him in the gut. Tens of thousands of other needy Alabamians got socked in the gut, too, according to The Wall Street Journal.

So if Maiden can’t get Medicaid, why doesn’t he apply for one of those supplements to enable him to buy insurance on his own? He can’t. The supplements weren’t designed for people like Maiden, with incomes below the federal poverty line. Expanded Medicaid was supposed to cover them. The supplements are only for people with incomes above the poverty line but below $46,680 a year.

So Ernest Maiden is too rich for Medicaid in Alabama but too poor for a supplement. His only option is to buy insurance on his own. But with no Medicaid and no supplement, the most basic plan would cost Maiden $11,600 per year---more than his total annual income.

So what should Ernest Maiden do?

He could quit his job so as to become poor enough to qualify for Medicaid in Alabama. He could move to Arkansas or Kentucky, the nearest two states that did expand Medicaid. But of course he doesn’t have a job in Arkansas or Kentucky.

He could go to an emergency room when he feels sick and hope he doesn’t die there before someone notices him.

He could find friends and relatives to tend to him when he falls ill.

He could exercise and eat right.

He could pray for good health.

Or he could camp out in front of the governor’s mansion in Montgomery until Governor Robert Bentley notices him. Maybe then Bentley will reconsider his decision not to expand Medicaid here. Several other governors who initially said no are now reconsidering.

Meanwhile, good luck to you, Ernest.

Richard H. Schmidt is a retired Episcopal priest, editor and author who lives in Fairhope. He can be reached at courier@gulfcoastnewspapers.com.