Two of five adults who recently have been uninsured living in states that have not yet decided to expand Medicaid eligibility under the Patient Protection and Affordable Care Act (PPACA) would likely have no new affordable health insurance options if their states do not eventually expand the program, according to a new Commonwealth Fund report.
The U.S. Supreme Court, in upholding the law in 2012, ruled that the federal government cannot require states to expand Medicaid eligibility. Currently, 26 states have said they will not, or may not, expand their Medicaid programs in 2014. In these states, the lowest-income adults – those earning below the federal poverty level, or less than $11,170 for an individual and $23,050 for a family of four in 2012 – will not have access to either the Medicaid expansion or subsidized private insurance through the new state insurance marketplaces and are likely to remain uninsured, according to the Commonwealth Fund.
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"A primary goal of the Affordable Care Act is to provide health insurance coverage to the millions of uninsured people in the U.S., the majority of whom have low and moderate incomes and struggle to afford the health insurance and health care they need," said Commonwealth Fund vice president and study coauthor Sara Collins, Ph.D. "However, if states don't expand their Medicaid programs, adults with the lowest incomes will continue to live without the health and financial security provided by the Affordable Care Act."
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 percent of adults whose incomes fell below 133 percent of the federal poverty level ($14,856 for an individual and $30,657 for a family of four in 2012) during the two-year period had spent some time uninsured.
Low-income families remain at risk, report says
The Commonwealth Fund offers several ways that the lowest-income adults are especially at risk if states do not expand their Medicaid programs.
Under PPACA, starting in 2014, people earning less than 133 percent of the federal poverty level will qualify for Medicaid. But because of the way the law was written, people making between 100 percent and 133 percent of the federal poverty level are eligible to purchase subsidized insurance coverage through the state marketplaces if they are not eligible for Medicaid.
However, people making less than 100 percent of the poverty level are not eligible for marketplace subsidies, since it was assumed that they would be enrolled in Medicaid – lawmakers did not anticipate the Supreme Court decision. So, not only will the lowest-income people be left without the opportunity to enroll in the xpanded Medicaid program, they will have no option to purchase subsidized health insurance through the marketplaces.
The Commonwealth Fund report found that in the 26 states that currently are not expanding their programs or are undecided, an estimated two of five (42 percent) adults who were uninsured any time over the two-year survey period earned less than the federal poverty level in one or both years.
