More than half of California’s uninsured qualify for assistance

“One in ten uninsured people (3.1 million) fall into the coverage gap due to their state’s decision not to expand Medicaid, and 15% of the uninsured (4.9 million) are undocumented immigrants who are ineligible for ACA coverage under federal law”, Kaiser says, noting, “A quarter of the remaining uninsured population is outside the reach of the ACA due to either their immigration status or their state’s decision not to expand Medicaid”.

“(M)isperceptions about cost, lack of awareness of financial assistance, and confusion about eligibility rules were barriers to a few eligible uninsured gaining coverage”, the report says.

Under the ACA, people earning up to 400% of the federal poverty level, which comes out to $33,465 for a family of four, can shop for health insurance on state and federal marketplaces, and part of their monthly premium could be subsidized through tax credits.

For the past three years, the Florida House has consistently blocked bills that would allow for an expansion of Medicaid, and refused to accept federal funds that would cover most of the cost. States that accepted the expansion generally had a larger share of their uninsured eligible for Medicaid, while states that declined the expansion had more people eligible for tax credits. Those in the coverage gap live in states that didn’t expand Medicaid, and they earn too much for Medicaid but not enough to qualify for exchange subsidies. In 2014, a total of 310,887 Kentuckians enrolled in Medicaid, according to the state’s Medicaid Expansion Report compiled by Deloitte consulting. “So, there may be a few work that needs to be done to get people who are Medicaid-eligible to sign up for coverage”.

In one sense, that’s good news for healthcare advocates trying to help the uninsured enroll, because it indicates many who otherwise might struggle to afford health coverage can qualify for assistance.

And almost 60 percent don’t know about or how to access the tax credits that can help them pay for marketplace insurance. There are 493,000 Texans eligible for but not enrolled in Medicaid and CHIP.

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.

Texas has the most people in the coverage gap with 766,000, followed by Florida with 567,000 people, Georgia with 305,000 people and North Carolina with 244,000 people. Those who are Medicaid eligible include people who were previously eligible as well as those newly eligible under the ACA. Others are confused about their eligibility, while many believe health plans are still too expensive even with subsidies, the foundation said. But drug prices and other medical costs keep going up, forcing state Medicaid this year to raise premiums 7 percent to keep them actuarially sound. For state-by-state estimates, see the table below; additional detail is available here. For purposes of this analysis, MT is considered an expansion state.

Here are six reasons why Americans are dropping coverage gained under the ACA, as presented by The New York Times. Anthony Damico is an independent consultant to the Kaiser Family Foundation.