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More Than 11 Million Uninsured Are Eligible for Subsidies

By Erin Mershon, CQ Roll Call

October 18, 2016 -- Almost half of the individuals who still lack health insurance would qualify for subsidies through the marketplace or through Medicaid, according to new data from the Kaiser Family Foundation.

About 6.4 million of the remaining uninsured could get Medicaid coverage in their state, and about 5.3 million could get subsidies on the exchanges set up by the health law. Still, more than that—about 15.5 million—don't qualify for any assistance. That includes about 2.6 million people in the so-called coverage gap who would be eligible if their states had chosen to expand Medicaid.

The new estimates underscore the challenges ahead for the Obama administration, as officials look to sign up more consumers during the health law's fourth open enrollment period, set to begin Nov. 1. Signing up all of the individuals eligible for exchange subsidies would dramatically expand the marketplaces. About 10 million people will be enrolled in marketplace coverage at the end of 2016, according to the latest estimates from federal health officials.

It will be more challenging to sign up those who are ineligible for subsidies or Medicaid. Among those individuals, Kaiser's analysis projects that 4.5 million have been offered employer-sponsored insurance, which makes them ineligible for subsidies. Another 3 million have too high an income to qualify. Others may lack eligibility or insurance because they are undocumented immigrants.

Kaiser identified the states that had the highest populations without insurance coverage. In West Virginia, Louisiana, Vermont, and Montana, more than 65 percent of the uninsured population is eligible for help. In California and Texas alone, some 2.5 million individuals are eligible for financial assistance.

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