Gap Health Insurance Coverage Between Jobs - How many uninsured are in the coverage gap and how many would be eligible if all states adopted Medicaid expansion?
The end of Medicaid continuous enrollment in March 2023 and the resumption of Medicaid waivers after a three-year hiatus during the pandemic are likely to revisit gaps in Medicaid coverage in the ten states that have not passed the Affordable Care Act (ACA). ) Medicaid expansion beginning in March 2023. During the pandemic, Medicaid enrollment has increased and the uninsured rate has dropped significantly due to continued enrollment. Once Medicaid cuts resume, the number of uninsured people is expected to increase and could be even higher in states without expansion. In expansion areas, all adults with incomes up to 138% of the Federal Poverty Level (FPL) are eligible for Medicaid, so many current enrollees will be eligible even if their incomes rise. However, in less developed states and where eligibility barriers are low and largely limited to parents, many people with below-poverty incomes who no longer qualify for Medicaid lack access to affordable options and remain uninsured.
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Notably, two states have taken the latest steps to accept Medicaid expansion. In November 2022, voters in South Dakota approved Medicaid expansion through a ballot measure, and in March 2023, legislation was signed into law approving Medicaid expansion in North Carolina, although the expansion is contingent on the passage of the state budget later in the year. . If North Carolina's expansion continues as expected, it will be 41
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Expansion status (including the District of Columbia), leaving ten states that did not accept expansion. This brief presents estimates of the number and characteristics of uninsured people in ten states that would not be eligible for Medicaid expansion if Medicaid expansion were adopted in 2021, using last year's data. It should be noted that this analysis focuses on the contingent number of newly eligible individuals if non-expansion countries accept the expansion. The total number of people eligible for Medicaid is large because it includes people with incomes 100%-138% FPL who are currently enrolled in marketplace coverage and others who have other coverage. An overview of the methodology under analysis can be found in Data and Methods, and more details in the Technical Appendices.
The coverage gap exists in states that did not adopt the ACA's Medicaid expansion for seniors who are not eligible for Medicaid or Marketplace benefits. The ACA expanded Medicaid to older adults with incomes up to 138% of FPL ($14,580 per year by 2023) with increased federal funding (currently 90%). This includes expanded eligibility for low-income parents and newly established Medicaid for adults without dependent children; However, a 2012 Supreme Court ruling made the extension more discretionary for states. As of March 2023, 41 states, including DC, had expanded Medicaid (Figure 1). As mentioned above, North Carolina approved the Medicaid expansion to pass the state budget later this spring.
In the remaining states that did not adopt the Medicaid expansion, an estimated 1.9 million people fell into the coverage gap. Seniors who fall into the coverage gap have incomes above their state's Medicaid eligibility but are below the poverty line, making them ineligible for funding from the ACA marketplace (Figure 2). When it was enacted, the ACA was not intended to allow states to stop expanding Medicaid; Also, people with incomes below the poverty line cannot get subsidies in the market.
Medicaid eligibility for seniors is much lower in states that have not expanded their programs. In these states, median parental income is only 38% of FPL, and annual income for a family of three in 2023 is $9,447, leaving childless adults in all non-expansion states (except Wisconsin). They are not allowed regardless of their income (Figure 3). In Texas, which has the lowest eligibility rate, parents in a family of three who earn more than $3,977 a year or $331 a month are not eligible for Medicaid. With the exception of Wisconsin, where there is no coverage for adults without children, more than three-quarters (76%) of people in the coverage gap belong to this group.
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Countries that have not implemented expansion have insurance rates that are almost twice the rate of expansion countries (15.4% compared to 8.1%). Access to care is worse for the uninsured than for the insured. In 2021, one in five uninsured people will go without needed medical care because of costs, and the uninsured are less likely than the insured to receive preventive care and services for major health conditions and chronic diseases.
Older people left in the security gap are concentrated in three southern countries. Four in ten people in the coverage gap live in Texas, which has the highest Medicaid eligibility thresholds and, as a result, the largest number of uninsured people (Figure 4). One in five people in the coverage gap live in Florida and 13% in Georgia. Overall, 97% of those in the security gap live in the South. Seven of the 16 states in the South have not approved Medicaid expansion, and the region has poor populations, uninsured seniors and high uninsured rates compared to other regions.
People in the safety gap are disproportionately people of color. Nationally, one-in-six (61%) people in shelters are people of color, a higher share than non-expansion states overall (47%) and among non-elderly adults (40%). . %) (Figure 5). This disparity partially explains the continuing disparity in health insurance coverage by race/ethnicity.
Despite low wages, about six in ten people in the protection gap belong to a family with a job, and almost half are self-employed (Figure 6). Working adults still have incomes below the poverty line because they work in low-wage jobs. People with incomes below the poverty line often do not have access to employer-based health insurance, or if it is available, it is often unaffordable. Common occupations among adults in the coverage gap are cashier, cook, waiter/waitress, construction worker, maid/house cleaner, salesperson, and janitor. For parents in non-expansion states, even part-time employment may make them ineligible for Medicaid.
Health Care Gap Widens Between Rich And Poor
Some people in the security gap have significant immediate health needs. An analysis of the 2021 American Community Survey shows that one in six (15%) people in the coverage gap have a functional disability, meaning they have significant difficulty with hearing, vision, cognitive function, walking, self-care, or independence. life . Even if they have an active disability, many cannot get Medicaid while on disability, leaving them uninsured. Older adults, ages 55-64, with the highest health needs make up 17% of the safety net population. Research has shown that uninsured people in that age group can leave health care needs untreated until they become eligible for Medicare at age 65.
If all states adopt the Medicaid expansion, approximately 3.5 million uninsured adults will become newly eligible for Medicaid. This number includes 1.9 million seniors in the coverage gap and an additional 1.6 million uninsured seniors with incomes between 100% and 138% of the FPL, many of whom are currently eligible for Marketplace coverage but not enrolled. (Figure 7 and Table 1). Most seniors who qualify for current exposure to the market qualify for plans with zero premiums; However, even without any copays, Medicaid can offer broader benefits and lower cost sharing compared to market coverage. The potential number of people reached by the Medicaid expansion varies by state.
Not counted in the above numbers, an estimated 173,000 people would be in the coverage gap and 154,000 uninsured adults with incomes 100%-138% FPL would be eligible for Medicaid if Medicaid continues in North Carolina. Budget (Table 2). An additional 281,000 North Carolinians with incomes of 100%-138% of FPL are currently insured in the ACA marketplace, newly eligible for Medicaid and the expansion.
Nearly ten years after the Medicaid expansion was implemented in January 2014, a large body of research is showing very positive results. Reports published in 2020 and 2021 reviewed more than 600 studies and concluded that the increase was linked to gains in coverage, improved access, and health and economic benefits for countries and providers. Recent studies are finding positive outcomes related to improved access to care, treatment and outcomes for cancer, chronic conditions, sexual and reproductive health, and behavioral health. The study points to evidence of reduced racial disparities in access and access, reduced mortality, and improved economic impact on providers (especially rural hospitals) and economic stability for individuals.
Million People—including 7.5 Million Women—gained Health Insurance Coverage Under The Affordable Care Act
Efforts to pass federal legislation to address the gap nationally have failed, and it says new implementation of the Medicaid expansion will receive a temporary financial boost under the American Rescue Plan Act (ARPA). Under ARPA, the newly approved expansion would be eligible for an additional 5 percent increase in average match level (FMAP) for two years, it said. This
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