5.2 million Americans will fall into Medicaid 'gap'

A new study by the Kaiser Family Foundation indicates millions of Americans will fall into the so-called "Medicaid gap" wherein they earn too much to be eligible for Medicaid benefits in their state and too little to obtain subsidies on the health insurance exchange.

Altogether, the Kaiser Family Foundation has estimated that 5.2 million Americans will fall into this gap, primarily within the 25 states that are not expanding Medicaid eligibility as part of the Affordable Care Act. They represent 27 percent of all uninsured adults in these states. In some states, such as Mississippi, that level reaches 37 percent. Texas has the highest number of uninsured that will be affected: 1.04 million, followed by more than 763,000 in Florida.

That decision will hurt not only those patients, but provider pocketbooks as well. According to StateLine Health News, community clinics in the 25 states that have opted out of Medicaid expansion stand to lose $555 million in additional payments next year. By contrast, those states that are expanding Medicaid stand to gain up to $2 billion.

Hospital associations have tried to respond, making scattered economic arguments for expansion.

"Health centers in opt-out states can be expected to struggle, falling further behind their expansion state counterparts in terms of service capacity, number of patients served (both insured and uninsured), and in their ability to invest in initiatives that improve the quality and efficiency of health care," according to StateLine, which quoted from a report authored by the George Washington University School of Public Health and Health Services.

Several states are still deciding whether to expand Medicaid. New Hampshire, for example, will likely hold a special session of its Legislature in November to discuss the issue, following the report of a special panel recommending expansion with the use of private insurance plans, the Union-Leader reported.

To learn more
- read the Kaiser Family Foundation study (.pdf)
- check out the StateLine Health News article
- here's the Union-Leader article

Related Articles:
Hospitals make the economic case for Medicaid expansion
Ohio may expand Medicaid through legislative sidestep
Medicaid holdout states will still see enrollment rise
A state-by-state look at uninsured rates under healthcare reform

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