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Analysis: Nearly 5M Residents Fall Into ACA 'Coverage Gap' in States Not Expanding Medicaid

Analysis: Nearly 5M Residents Fall Into ACA 'Coverage Gap' in States Not Expanding Medicaid

December 19, 2013 — Nearly five million U.S. residents with incomes that would make them eligible for Medicaid under the Affordable Care Act (PL 111-148) will not have access to such coverage because they live in states that are opting out of the Medicaid expansion, according to a new report from the Kaiser Family Foundation, CQ HealthBeat reports.

Those people also will not be eligible for federal subsidies to purchase private coverage through the ACA's insurance marketplaces because their incomes fall under the threshold to qualify for the subsidies, KFF analysts reported (Adams, CQ HealthBeat, 12/17). In nearly all of those states, childless adults will remain ineligible for Medicaid, KFF noted (Howell, Washington Times, 12/17).

Under the ACA, states have the option to extend Medicaid eligibility to adults with incomes up to 138% of the federal poverty level. Nearly half of states have declined to expand the program. Meanwhile, individuals with incomes between 100% and 400% of the poverty level can qualify for the subsidies through the insurance exchanges.

According to the KFF report, 4.8 million people fall into the "coverage gap" created by the disparity between eligibility for Medicaid and the subsidies toward private coverage (CQ HealthBeat, 12/17).

Southern States, Minorities Disproportionately Affected

Many people who will be affected by the coverage gap live in the South and in states that have some of the highest rates of uninsured residents. Specifically, the report found that more than 20% of those individuals live in Texas, 16% live in Florida, 8% live in Georgia and 7% live in North Carolina (Washington Times, 12/17).

The report also found that 2.6 million of those people, or 53%, are minorities. Forty percent of uninsured blacks whose incomes would qualify them for Medicaid coverage under the expansion will not have access to the coverage, compared with 29% of uninsured whites and 24% of uninsured Hispanics. Many states with large Hispanic populations, such as California and Arizona, are participating in the Medicaid expansion, CQ HealthBeat notes.

"These continued coverage gaps will likely lead to widening racial and ethnic as well as geographic disparities in coverage and access," the report said (CQ HealthBeat, 12/17).