Wednesday, October 16, 2013

Fwd: qotd: 5.2 million people fall into ACA coverage gap

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-------- Original Message --------
Subject: qotd: 5.2 million people fall into ACA coverage gap
Date: Wed, 16 Oct 2013 13:28:28 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

The Kaiser Commission on Medicaid and the Uninsured
October 2013
The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand

The expansion of Medicaid, effective in January 2014, fills in
historical gaps in Medicaid eligibility for low-income adults and has
the potential to extend health coverage to millions of currently
uninsured individuals. This expansion essentially sets a national
Medicaid income eligibility level of 138% of poverty (about $27,000 for
a family of three) for adults. The expansion was intended to be national
and to be the vehicle for covering low-income individuals, with premium
tax credits for Marketplace coverage serving as the vehicle for covering
people with higher incomes. However, the June 2012 Supreme Court ruling
made the expansion of Medicaid optional for states, and as of September
2013, 26 states did not plan to implement the expansion.

In states that do not expand Medicaid, over five million poor uninsured
adults (5.2 million people) have incomes above Medicaid eligibility
levels but below poverty and may fall into a "coverage gap" of earning
too much to qualify for Medicaid but not enough to qualify for
Marketplace premium tax credits. Most of these people have very limited
coverage options and are likely to remain uninsured.

The ACA envisioned people below 138% of poverty receiving Medicaid and
thus does not provide premium tax credits for the lowest income. As a
result, individuals below poverty are not eligible for Marketplace tax
credits, even if Medicaid coverage is not available to them. Individuals
with incomes above 100% of poverty in states that do not expand may be
eligible to purchase subsidized coverage through the Marketplaces;
however, only about a third of uninsured adults (3.2 million people) who
could have been eligible for Medicaid if their state expanded fall into
this income range. Thus, there will be a large gap in coverage for
adults in states that do not expand Medicaid.

Comment: According to this report, "Nationally, over five million poor
uninsured adults will fall into the 'coverage gap' that results from
state decisions not to expand Medicaid, meaning their income is above
current Medicaid eligibility but below the lower limit for Marketplace
premium tax credits." That is, they are not eligible for Medicaid, and
at an income below 138% of the federal poverty level, they are not
eligible for subsidies and therefore cannot possibly afford to purchase
private plans. They will remain uninsured, even though they have the
least ability to pay out-of-pocket for health care.

These individuals falling into the coverage gap represent about
one-sixth of the total number of individuals who will remain uninsured
(31 million). Supposedly the Affordable Care Act was designed to make
health care affordable for everyone, with an emphasis on Medicaid or
private plan subsidies for those who could least afford to pay for
coverage. By this standard, ACA can be considered a dud.

Let's do it right. Let's enact a single payer national health program
that provides health care for everyone while separating the funding by
moving it to the tax system. That would eliminate any connection between
receiving health care and having to pay for it. Needing health care is
bad enough without being assessed charges (in essence financial
penalties) for obtaining that care.

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