Commonwealth Fund identifies Medicaid gap

September 9, 2013

In state that opt out of Medicaid expansion, millions of low-income people will miss out on subsidies too

With 26 states opting out of Medicaid expansion, millions of adults will fall into a policy gap in which their only option is to pay full-price premiums for coverage. According to a report released by the Commonwealth Fund on September 5, two in five uninsured adults would likely have no new affordable health insurance options if their states don’t eventually expand Medicaid.

In the 26 opt-out states, the lowest-income adults-those earning below the federal poverty level (FPL)-will not have access to either expanded Medicaid or subsidized private insurance through the state insurance marketplaces. The subsidies were originally designed under the assumption that all states would expand, and therefore, are allocated only to those with incomes between 133% and 400% of FPL-those above the Medicaid eligibility threshold. And nothing is currently allocated to those between 100% and 133% of FPL because it was assumed they would be covered by Medicaid.

Although those who fall into the 100% to 133% gap are eligible to purchase plans on the exchanges in any state, they won’t receive subsidies.

55 million Americans

The report, based on a survey of U.S. adults ages 19 to 64 found that an estimated 55 million Americans were uninsured for all or part of the time from June 2010 to September 2012. In the 26 states that have not yet decided to expand Medicaid, 72% of adults whose incomes fell below 133%  of FPL during the two-year period had spent some time uninsured.

Federal poverty level was $11,170 for an individual and $23,050 for a family of four in 2012.

According to the report, in the 26 states that are currently not expanding their programs or are undecided, an estimated two of five (42%) adults who were uninsured any time over the survey period earned less than FPL in one or both years.

Report authors suggest that states should pursue expansion of Medicaid or federal lawmakers should allow those in the gap to receive subsidies.