Analysis Provides State-by-State Estimates of Poor Uninsured Adults Who Fall Into the “Coverage Gap” Under the Affordable Care Act

by Sabrina I. Pacifici on October 16, 2013

“A new analysis from the Kaiser Family Foundation provides state-level data showing how many impoverished uninsured adults fall into the Affordable Care Act’s “coverage gap” — those who will be ineligible to enroll in Medicaid and also will not qualify for financial assistance to buy private health insurance in the new marketplaces in states that are not expanding Medicaid under the law. The number of uninsured adults with incomes below the poverty level who will be ineligible for these two main ways that the ACA expands coverage to the uninsured when the law takes full effect on Jan. 1 ranges from more than 1 million in Texas, to 242,000 in Louisiana, and 17,000 in both Alaska and Wyoming.  In all, 26 states are not moving forward with the Medicaid expansion, leaving 5.2 million poor uninsured adults with very limited coverage options, and likely to remain without health insurance. Over half of those in this “coverage gap” live in five states: Texas, Florida, Georgia, North Carolina and Ohio. The gap opened up when the Supreme Court ruling in 2012 made the ACA’s Medicaid expansion optional for states. As enacted in 2010, the law would have set a national eligibility level for Medicaid of 138 percent of the federal poverty level, or $15,856 for an individual and $26,951 for a family of three. No longer would Medicaid eligibility be tied to whether individuals fell into categories such as being a parent of a dependent child, a change that in many states meant the program would be open to non-disabled childless adults for the first time. Meanwhile, the ACA’s premium tax credits were designed to make private insurance plans sold in the new marketplaces affordable for millions of people with generally higher incomes, those ranging from 100 percent to 400 percent of the poverty level — or $11,490 to $45,960 for an individual, and $19,530 to $78,120 for a family of three.”

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