The Medicaid coverage gap affects over 1.6 million uninsured adults, predominately people of color (65%) who are caught between qualifying for Medicaid and obtaining affordable health insurance through the Affordable Care Act (ACA) marketplaces. The ACA aimed to cover adults with incomes up to 138% of the federal poverty level (FPL), but the Supreme Court allowed states to opt out of expansion, leaving a gap for those below 100% of the FPL. Closing this coverage gap would help reduce the remaining ethnic and racial disparities in health coverage that the ACA has yet to fully address.
Key Findings:
Adults in the coverage gap are more likely to work in low-wage industries or caregiving roles without access to employer-provided health coverage.
The gap mainly exists in the ten states that have not adopted the ACA Medicaid expansion, with Texas and Florida being significant contributors.
States in the South with higher Black and Latino populations are less likely to have expanded Medicaid.
Expansion states have experienced better access to healthcare, decreased uninsured rates, and improved health outcomes.
Medicaid expansion reduces medical debt and financial hardships for enrollees, leading to greater financial stability.
Expansion is cost-effective for states; reducing expenditures on other programs and increasing federal funding.
Reduces uncompensated care costs and supports the financial stability of hospitals, particularly in rural areas.
Federal solutions are needed to close the coverage gap like the Bridge to Medicaid Act and the ACCESS Act to extend coverage in non-expansion states.
Recommends making ACA premium tax credit improvements permanent.
The full report can be found here.
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