Expansion “Gap” Puts Coverage Off Limits to 10% of Remaining Uninsured

According to a report accompanying the KFF survey, in states that did not expand Medicaid, almost 1 in 5 (19%) of those who remain uninsured fall into the coverage gap, while about two-third as many are eligible for Medicaid under rules that existed before the ACA took effect. Although the majority of states have followed suit, there are still more than a dozen holdouts that have chosen not to expand their Medicaid coverage, which has exacerbated disparities in different parts of the country. “But the breakdown of who the remaining uninsured are suggests that many may be hard to reach and will still remain uninsured”.

Nationwide, an estimated 8.5 million are eligible for Medicaid but have not enrolled, and another 7.1 million are eligible for tax credits on the Marketplace but have not signed up for coverage.

A new study Tuesday concluded that more than half of Connecticut residents without health insurance are not taking advantage of the state’s expanded Medicaid program and subsidies available under the Affordable Care Act – Obamacare.

About 558,000 would have qualified for Medicaid had Florida expanded eligibility as envisioned by the federal health law. You can get percentages by running your cursor over the boxes, but here are the raw numbers: 1,064,000 excluded because of their immigration status; 652,000 ineligible for tax credits because their employer offers coverage; and 416,000 ineligible for tax credits because they earn too much.

The health law defines affordability – and calculates eligibility for financial aid – based on the cost of individual, rather than family coverage. Also in the works are electronic tools to help consumers answer basic questions, such as whether the health plans they’re looking at include their doctors and cover their medications.

The research team’s finding that there are more than 300,000 more Medicaid eligible will not be good news for Florida lawmakers.

The statewide managed care program that Medicaid launched in 2013 and 2014 has trimmed the per-enrollee cost, the economic report says. While the elderly and disabled comprise about 30 percent of Florida’s Medicaid caseload, it shows they account for 63 percent of program spending.

Millions of people have enrolled in these new coverage options, but millions of others are still uninsured.

About 9.9 million people were enrolled in the state and federal health insurance exchanges at the end of June – a 15% drop from the 11.7 million who were enrolled at the end of February. About one-fourth are either newly eligible for Medicaid, or always were. About 15 percent of the uninsured are illegal immigrants who don’t qualify for the federal Marketplace coverage.

The remainder of the uninsured either has an offer of ESI (4.9 million, or 15%) or has an income above the limit for premium tax credits but could purchase unsubsidized Marketplace coverage (3.7 million, or 12%). Because adults with incomes from 100% to 138% of poverty in non-expansion states can receive tax credits for Marketplace coverage, a larger share of the uninsured population in those states is eligible for Marketplace tax credits than in expansion states (27% versus 17%).