An estimated 4.8 million U.S. adults are expected to fall into what’s been called the “Medicaid gap,” unable to qualify for Medicaid and ineligible for subsidized health insurance through the Obamacare state marketplaces, says a new report by the Kaiser Family Foundation.
They have too much income to qualify for Medicaid under the current rules in their state and they earn too little to qualify for a subsidy under Obamacare, writes Greg Sargent in The Washington Post. Consider it a health insurance no man’s land. (See: “Ask Stacy: Isn’t Obamacare Going to Wreck the Economy?“)
That’s because 25 states have not taken the federal government up on its offer to fund the expansion of Medicaid, a federal health insurance program for the very poor that’s administrated by the states. The U.S. Supreme Court decision that upheld the constitutionality of the Affordable Care Act also gave states the option to not participate in the Medicaid expansion.
The Kaiser Family Foundation report says:
Medicaid eligibility for adults in states not expanding their programs is quite limited — the median income limit for parents in 2014 will be 47 percent of poverty, or an annual income of about $9,200 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible.
It wasn’t supposed to be this way. Those who earn too little to qualify for a subsidy under the Obamacare rules were supposed to be provided coverage by the expansion of Medicaid in their states.
Other information from the Kaiser Family Foundation report:
- Of the 4.8 million, 47 percent are white, 27 percent are black and 21 percent are Hispanic.
- 11 of the 25 states are in the South, and “nearly 80 percent of people in the coverage gap reside in the South,” which has a disproportionate number of uninsured people and more limited access to Medicaid.
- “More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, 8 percent in Georgia, 7 percent live in North Carolina, and 6 percent live in Pennsylvania,” the report says.
- More than half are either middle-aged (35 to 54) or between 55 and 64. Medicare, another government health insurance program, kicks in at age 65.
- 49 percent of those in the gap are women.
- “Nearly two-thirds (60 percent) of people in the coverage gap are in a family with a worker, and 54 percent are working themselves.” But many are working part time or at jobs where health insurance is not available for employees.
In short, those who fall in the gap will more than likely remain uninsured because they are “ineligible for publicly financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own,” says the Kaiser report.
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