Report: 5.2 Million Adults Will Fall Into ACA Coverage Gap Next Year
About 5.2 million poor, uninsured adults will fall into the 鈥渃overage gap,鈥 created by 26 states聽choosing not to expand Medicaid under the federal health law next year, according to a聽by聽the Kaiser Family Foundation. (KHN is an editorially independent聽program of the foundation.)
These people are projected to have incomes too high to qualify for their state鈥檚 existing Medicaid programs, but below the federal poverty level聽(nearly $11,500 for an individual)聽required聽to be eligible for federal subsidies to buy private coverage on聽the new online insurance marketplaces set up by the Affordable Care Act. Medicaid is the state-federal health insurance program for the poor.
鈥淢illions of adults will remain outside the reach of the ACA and continue to have limited, if any, options for health coverage,鈥 the study concludes.
The law provides full federal funding for three years to states聽that expand Medicaid to cover聽residents under 138 percent of the poverty level (or just under $15,900 for an individual). But the Supreme Court made聽that requirement effectively聽optional for states, and most Republican led-states have opted against expanding the program.
There is no deadline by which states must opt to expand Medicaid, and a few states are still considering it.
Nearly half of the uninsured in the coverage gap live in Texas (1 million), Florida (763,980) and Georgia (409,350) 鈥 largely because those states have the most uninsured and limited Medicaid eligibility today.
Alabama, Mississippi and Louisiana聽also will be especially hard hit,聽with more than a third of their聽uninsured adults falling into the coverage gap next year, the study shows. These states will feel the pinch because they have higher rates of poor uninsured adults and their existing Medicaid programs have聽some of the nation’s聽the tightest eligibility rules. Nationally, about 27 percent of uninsured adults in states not expanding Medicaid will find themselves in that gap, the study said.
The study excludes illegal immigrants聽because they would not have been eligible for coverage under the law. The study was based on聽 Census data from 2012 and 2013 as well as on state Medicaid eligibility rules for 2014.
