Not long ago, I discussed how the Medicaid expansion was appearing to be lowering Medicaid spending in states that accepted it relative to states that were denying it. But that’s just the financial aspect of the decision to participate or not. It’s important that we not overlook the access aspects as well. The Kaiser Family Foundation has released a report entitled, “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid” that touches on this subject.
It’s important to remember that Medicaid, as it exists today, is far from a universal safety net insurance program for poor people in the United States. Coverage has been restricted to children, pregnant women, the elderly, the blind, and the disabled. That means that childless adults have often had no options for coverage, no matter how poor they are. Moreover, the coverage for parents is scant in many states.
Because of the way that the ACA was written, people who make less than 100% of the poverty line are ineligible for subsidies. Given the states who are refusing expansion, this means that more than 5 million Americans will remain uninsured next year because they will earn too little to qualify for subsidies in the exchange. Coverage options are already limited; that’s why they are uninsured right now. With no Medicaid expansion, there’s no reason to think things will improve next year.
Ironically, in states where the Medicaid expansion will occur, things were already better relative to those states who are refusing to participate. As it currently stands, the median eligibility level for a parent to obtain Medicaid in a participating state was 106%. That will go up to 138% with the expansion. In states that are refusing the expansion, median eligibility was 49%, or about $7600 for a single mother with a child. Think about that for a minute: a single mom working 20 hours a week making $7.50 an hour is too “rich” for Medicaid in those states. Next year, the median eligibility level is expected to go down to 47%.
Of those 5 million people who will fall into the “coverage gap,” about one million of them live in Texas. This is because Texas has a very large population of uninsured, and also has a very low level of eligibility for Medicaid. Things are almost as bad in Florida, where about 763,000 people will be denied Medicaid in the expansion. In fact, just five states – Texas, Florida, Georgia, North Carolina, and Ohio – account for about half of the more than 5 million people in this gap.
While we focus in the next few months on the millions of people attempting to sign up for coverage in the exchanges, and hear about the many other millions getting Medicaid in states that are accepting the expansion, it worth remembering that there are 5 million Americans out there who will be left out in the cold. They are among the least well off. They’re in some of the states with the most poverty. And there’s little that is being done to correct this problem.