Even if healthcare.gov, the web portal for federal health insurance exchange, worked perfectly, more than 5 million poor, uninsured adults, many of them Black, will continue to go without coverage, because they live in states that didn’t expand Medicaid, according to a recent brief by the the Kaiser Family Foundation.
Through the Affordable Care Act, the federal government agreed to pay 100 percent of the cost of the Medicaid expansion through 2016 and at least 90 percent through 2020.
The Obama administration planned for nationwide expansion of Medicaid, the health insurance program that covers the poor and disabled, setting the Medicaid income eligibility at 138 percent of the federal poverty level, or roughly $27,000 for a family of three. In June 2012, the Supreme Court ruled that states could decide whether they want to expand Medicaid. According to the Kaiser Commission, more than half of states, a majority in the southeast, decided not to expand Medicaid. That decision created a coverage gap affecting 27 percent of uninsured adults.
“A fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Fifteen percent live in Florida, eight percent in Georgia, six percent live in North Carolina, and another six percent live in Ohio,” the Kaiser Commission brief said.
More than half of all Blacks live in eight states: Texas, Florida, Georgia, New York, California, North Carolina, Illinois, and Maryland.
According to the Kaiser Commission on Medicaid and the Uninsured, “The largest uninsured nonelderly Black populations reside in Florida (718,800), Texas (613,100), and Georgia (594,600). In addition, Blacks comprise a large share of the uninsured population in the District of Columbia (52%), Mississippi (48%), and Louisiana (42%).”
Florida, Texas, Georgia, Mississippi and Louisiana chose not to expand Medicaid leaving billions of dollars unspent, forcing many of their citizens to either go without health insurance or to sign up for health insurance on the federal-facilitated marketplace.
Because 40 percent of all Blacks are under the age 26, compared to 30 percent of Whites, the very people needed to make the health care formula work may be less inclined to participate.
According to the Kaiser Commission brief, “…With many states opting not to implement the Medicaid expansion, millions of adults will remain outside the reach of the ACA and continue to have limited, if any, option for health coverage: most do not have access to employer-based coverage through a job, few can afford coverage on their own, and most are currently ineligible for public coverage in their state.”
The brief continued: “While a small share may be eligible to purchase subsidized coverage through the new Health Insurance Marketplaces, most have incomes below the poverty level and thus will be ineligible for these premium tax credits.”
During a Webinar for journalists, Rachel Garfield, senior researcher Kaiser Commission on Medicaid and the Uninsured, said that in all states there are people who will continue to be uninsured, because of their immigration status, people who opt to pay the penalty, or people who are exempt from the penalty.
“One of the things that’s very important to keep in mind, as the law is unfolding is how is outreach working are people aware of their coverage options do they understand their coverage options,” said Garfield. “We are going to continue to shine a light on who is being left out and who is falling between the gaps for various reasons.”