Medicaid Coverage Gap Looms For Many Uninsured

Overhauling the American health care system and providing access to care to millions of Americans is a necessarily multifaceted endeavor. Between measures meant to lower the cost of health care delivery, the exchanges aimed at making insurance affordable, and Medicaid expansion to cover the poorest, no American was meant to be left out. However, the decision to expand the mostly federally funded Medicaid was left to the states. Florida’s decision makers chose not to and now over 700,000 Floridians find themselves stuck in the “coverage gap.”

Medicaid Coverage Gap Looms For Many Uninsured
Florid Today, October 31, 2013

WASHINGTON — Nearly 2 in 3 uninsured low-income people who would qualify for subsidized coverage under President Barack Obama’s health care law may be out of luck next year because their states have not expanded Medicaid. Florida is among those.

An Associated Press analysis of figures from the Urban Institute finds a big coverage gap developing, with 9.7 million out of 15 million potentially eligible adults living in states that refused the expansion. The Kaiser Family Foundation reported in October the number of Floridians falling into the gap is nearly 764,000.

That a majority of the neediest people who could be helped by the law instead remain uninsured is a predicament unforeseen by Obama and congressional Democrats who designed a sweeping extension of the social safety net. The law’s historic promise of health insurance for nearly all U.S. residents would not be fulfilled as envisioned.

It’s the direct consequence of last summer’s Supreme Court decision that gave states the right to opt out of Medicaid expansion, combined with unyielding resistance to the law from many Republican state lawmakers.

Expanding Medicaid is essential to Obama’s two-part strategy for covering the uninsured.

As the law stands, middle-class people without job-based coverage can get tax credits to help them buy private insurance. But the law calls for low-income people to enroll in Medicaid, expanded to accommodate a largely excluded group: adults with no children at home. Expanded Medicaid would cover about half the 25 million to 30 million people who could be helped by the law.

Twenty-five states and the District of Columbia have decided to accept the expansion, which is fully financed by Washington for the first three years and phases down gradually to a 90 percent federal share.

But the majority of low-income Americans newly eligible for Medicaid under the law live in states such as Florida, Texas and Georgia, where political opposition remains formidable.

“Because of the Supreme Court’s decision making Medicaid expansion optional with the states, we’re going to see some pretty significant differences in this country from one place to another in terms of access to health care and access to health insurance,” said Gary Cohen, the Health and Human Services official overseeing the rollout of the law.

Republican state lawmakers continue to oppose the expansion for several reasons. Many believe Medicaid has too many problems already. Others worry that Washington will renege on financing, and some believe health care is an individual responsibility.

GOP health policy expert Gail Wilensky says she did not expect so many states to turn down the Medicaid expansion.

“For me, it is really quite surprising — particularly in the years with 100 percent federal funding — that so many states are saying ‘no,’ ” Wilensky said. “This is depriving the poorest of their citizens of an important benefit.” Wilensky ran Medicare and Medicaid during the George H.W. Bush administration.

Beginning next year, states will have an opportunity in each calendar quarter to opt in, and if they later want to drop out, they can do that. Low-income residents of states refusing the expansion will be exempted from tax penalties for being uninsured. Those penalties also take effect next year.

An earlier Urban Institute analysis of the expansion found that less than $100 billion in state spending could trigger nearly $1 trillion in federal dollars over a decade.

The expansion was supposed to cover households making up to 138 percent of the federal poverty level, about $15,860 for an individual or $32,500 for a family of four.

Under the law, Medicaid is the only coverage option for people below the poverty line, $11,490 for an individual, or $23,550 for a family of four. The poor cannot get subsidized private coverage in the new health insurance markets.

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