Who is Impacted by the Coverage Gap in States that Have Not Adopted the Medicaid Expansion? - January 2016

Who is Impacted by the Coverage Gap in States that Have Not Adopted the Medicaid Expansion?

Updated January 2016

Figure 1

Employer-Sponsored,

55%

Medicaid/ Other Public,

26%

Uninsured, 12%

Private Non-

Group, 7%

NOTES: Medicaid and other public coverage includes: CHIP, other state programs, Medicare and military related coverage. Data may not total 100% due to rounding. SOURCE: Kaiser Family Foundation analysis of the 2015 ASEC Supplement to the CPS.

An estimated 32.3 million nonelderly individuals were uninsured in 2014.

270.2 M Nonelderly

Figure 2

27%

27%

28%

400%+ FPL 15%

Family Income (%FPL)

<100% FPL

100-199% FPL

200-399% FPL

59% 26%

15%

Parent Status

NOTES: The U.S. Census Bureau's poverty threshold for a family with two adults and one child was $19,055 in 2014. Data may not total 100% due to rounding. SOURCE: Kaiser Family Foundation analysis of the 2015 ASEC Supplement to the CPS.

45%

14%

34%

5%

3%

Race

The majority of the uninsured are low-income adults, and more than half are people of color.

Total = 32.3 Million Uninsured

Childless Adults

Children

Parents Hispanic

White non-

Hispanic

Other

Asian/Native Hawaiian or

Pacific Islander

Black

Figure 3

Prior to the ACA, Medicaid eligibility was limited to specific low-income groups.

Not Eligible

Figure 4

Expanding Medicaid to low-income adults is a core component of the ACA coverage expansions.

Medicaid Coverage For Low-Income Individuals

Employer-Sponsored Coverage

Marketplaces With Subsidies For Moderate Income

Individuals

Individual Mandate

Health Insurance Market Reforms

Universal Coverage

Figure 5

NOTES: 138% FPL = $16,242 for an individual and $27,724 for a family of three in 2015.

As enacted, the ACA Medicaid expansion would cover adults up to 138% FPL in all states, filling long-standing gaps in coverage.

Figure 6

NOTES: Current status for each state is based on KCMU tracking and analysis of state executive activity. *AR, IA, IN, MI, MT, NH and PA have approved Section 1115 waivers. Coverage under the PA waiver went into effect 1/1/15, but it has transitioned coverage to a state plan amendment. Coverage under the MT waiver went into effect 1/1/16. LA’s Governor signed an Executive Order to adopt the Medicaid expansion on 1/12/16, but coverage under the expansion is not yet in effect. WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion. SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts, updated January 12, 2016. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/

But, the Supreme Court effectively made the Medicaid expansion a state option.

WY

WI*

WV

WA

VA

VT

UT

TX

TN

SD

SC

RI

PA*

OR

OK

OH

ND

NC

NY

NM

NJ

NH*

NV NE

MT*

MO

MS

MN

MI*

MA

MD

ME

LA*

KY KS

IA*

IN* IL

ID

HI

GA

FL

DC

DE

CT

CO

CA

AR* AZ

AK

AL

Adopted (32 States including DC)

Adoption under Discussion (3 States)

Not Adopting At This Time (16 States)

Status of Medicaid Expansion Decisions, January 12, 2016

Figure 7

297%

213%

138% 138%

214% 199%

44%

0%

Children Pregnant Women Parents Childless Adults

Adopted the Medicaid Expansion (32 states, including DC) Not Adopting at this Time (19 states)

Median Medicaid/CHIP Income Eligibility Thresholds, January 2016

NOTE: State-reported eligibility levels as of Jan. 1, 2016, updated to reflect Medicaid expansion adoption in Louisiana as of Jan. 12, 2016. Eligibility levels include the standard five percentage point of the federal poverty level (FPL) disregard. As of 2015, the FPL was $20,090 for a family of three and $11,770 for an individual. SOURCE: Based on results from a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, 2016 with data updates.

Medicaid eligibility for adults remains limited in states that have not adopted the Medicaid expansion.

Figure 8

In states that have not adopted the Medicaid expansion, poor adults fall into a coverage gap, earning too much to qualify for Medicaid but too little for subsidies for Marketplace coverage.

as of October 2014 as of January 2016

44% FPL $8,840 for parents in a family of three

$11,770 for an individual

$47,080 for an individual

Figure 9

TX 26%

FL 20%

GA 11%

NC 8%

Other States that Have Not Expanded Medicaid

35%

Note: Totals may not sum to 100% due to rounding. Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of January 2016 and 2015 Current Population Survey data.

South 89%

Midwest 7%

Northeast 1%

West 3%

An estimated 2.9 million nonelderly adults fall into the coverage gap, most of whom reside in the South.

Total = 2.9 Million in the Coverage Gap

Distribution By Geographic Region: Distribution By State:

Figure 10

White 45%

Black 28%

Hispanic 23%

Other 4%

19-24 years 24%

25-34 years 24%

35-54 years 35%

55-64 years 17%

More than half of adults in the coverage gap are adults of color. Adults in the coverage gap are of varying age and health status.

Total = 2.9 Million in the Coverage Gap

Distribution By Age:

Distribution By Race/Ethnicity:

Excellent or Very Good 50% Good

32%

Fair or Poor 18%

Distribution By Health Status:

Note: Totals may not sum to 100% due to rounding. Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of January 2016 and 2015 Current Population Survey data.

Figure 11

No worker 38%

Part-time worker

21%

Full-time worker

41%

Notes: Industry classifications: Agriculture/Service includes agriculture, construction, leisure and hospitality services, wholesale and retail trade. Education/Health includes education and health services. Professional/Public Admin includes finance, professional and business services, information, and public administration. Manufacturing/Infrastructure includes mining, manufacturing, utilities, and transportation. Totals may not sum to 100% due to rounding. Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of January 2016 and 2015 Current Population Survey data.

48% 55%

6%

14%

46% 17%

8%

6%

Nearly two-thirds of adults in the coverage gap are in a family with a worker, but most work in jobs that are unlikely to offer insurance.

Family work status :

Total = 2.9 Million in the Coverage Gap

Firm size and industry among those working:

<50 employees

50-99 employees

100+ employees

Agriculture/ Service

Education/ Health

Professional/ Public Admin

Manufacturing/Infrastructure

Other

Total = 1.5 Million Workers in the Coverage Gap

Figure 12

11% 10%

21%

7% 5% 11%

Total Whites Blacks Hispanics Other All People ofColor

Uninsured Black adults are more likely to fall into the coverage gap than other racial/ethnic groups.

27.5 M 9.0 M 3.9 M 12.5 M 2.0 M 14.9 M

Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of January 2016 and 2015 Current Population Survey data.

Total Uninsured

Adults

Share of Uninsured Adults Who Fall into the Coverage Gap, by Race/Ethnicity:

Figure 13

22%

27%

NOTES: Numbers may not sum to subtotals or 100% due to rounding. Tax-Credit Eligible share includes adults in MN and NY who are eligible for coverage through the Basic Health Plan. SOURCE: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of January 2016 and 2015 Current Population Survey data.

If all states adopted the Medicaid expansion, the coverage gap would be eliminated and 59% of the nonelderly uninsured would be eligible for financial assistance.

Total = 32.3 Million Nonelderly Uninsured

32%

17%

25%

Medicaid-Eligible Adult 18%

Medicaid-Eligible Adult

Tax-Credit Eligible Tax-Credit Eligible

Unsubsidized Marketplace/ESI Offer

Unsubsidized Marketplace/ESI Offer

Medicaid-Eligible Child, 10% Medicaid-Eligible Child,

10%

In the Coverage Gap, 9%

Ineligible due to Immigration Status, 15%

Ineligible due to Immigration Status, 15%

If All States Expanded Medicaid Based on Current Medicaid Expansion Decisions

Eligible for Financial

Assistance 59%

Eligible for Financial

Assistance 49%