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Kaiser: Uninsured in Coverage Gap Likely to Remain Uninsured

By CQ Staff

October 16, 2013 -- The coverage gap for poor Americans who won't be able to enroll in Medicaid or get subsidies in the new health care exchanges is concentrated in five of the 26 states that have decided not to expand Medicaid, according to a new analysis by the Kaiser Family Foundation.

The nonpartisan foundation found that of the 5.2 million uninsured people who won't qualify for Medicaid because the states they live in are not expanding the program, more than half live in Texas, Florida, Georgia, North Carolina and Ohio. In Texas, the analysis says, more than 1 million people are affected.

"Most of these people have very limited coverage options and are likely to remain uninsured." the Kaiser report says. This coverage gap affects people whose annual incomes are below the federal poverty level but who live in states where that income still doesn't qualify them for Medicaid. The authors of the health care law (PL 111-148, PL 111-152) never envisioned this problem. They thought by setting the eligibility level for Medicaid under the expansion at 138 percent of the federal poverty line, they weren't leaving anyone out. People who earned up to that would be in Medicaid. But the authors didn't count on the Supreme Court ruling that states that didn't expand Medicaid under the health law wouldn't lose the rest of the federal Medicaid funds. And so far 26 states have decided not to expand.

The only option for those low-income people who will not qualify for Medicaid would be to try and get insurance through the new marketplaces. But, the Kaiser study points out, the health care law prohibits anyone with an income below the poverty line to get a federal premiums subsidy, the assumption being that such people would enroll in Medicaid. Without a federal subsidy, these Americans are unlikely to be able to afford to buy insurance.

The group affected by this gap, the Kaiser report says, "represents more than a quarter (27 percent) of all the uninsured adults ages 19 to 64 in the states not moving forward with the Medicaid expansion. The share ranges from 18 percent in Alaska to 37 percent in Mississippi."

These uninsured people, the report also explains, will face significant problems accessing health care.

"People in the coverage gap are likely to face barriers to needed health services or, if they do require medical care, potentially serious financial consequences," the report says. "Further, the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be stretched in these states."

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