Breaking down the remaining uninsured population

Health insurance, pen and stethoscope

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Despite the Affordable Care Act’s record gains in boosting the number of people with health plans, millions of uninsured people still qualify for financial help to get coverage, according to a new analysis.

Of the 27 million nonelderly uninsured, approximately 11.7 million, or 43 percent, are eligible for financial help to pay for health plans, about half through the marketplace and half through Medicaid, according to an estimate from the Kaiser Family Foundation.

Of the remaining uninsured, 14.1 million are from non-Medicaid expansion states, says the report. Kathy Hempstead, a senior adviser at the Robert Wood Johnson Foundation previously called Medicaid expansion a "fiscal win" for state budgets.

Within the uninsured population, some remain ineligible for coverage, some may simply not be informed of their coverage options, and yet others may determine health plans are unaffordable even while accounting for financial assistance, the report notes.

Further, undocumented immigrants are prohibited from obtaining both Medicaid and marketplace coverage.

One key contributor to the uninsured rate is the 19 states' refusal to expand Medicaid, says the report. People with incomes less than the federal poverty line are not eligible for marketplace subsidies or tax credits, yet this produces a coverage gap for individuals who earn too much to qualify for Medicaid in nonexpansion states.

Kaiser Family Foundation breaks down the remaining uninsured as follows:

  • 2.6 million children qualify for Medicaid or some other public coverage program.
  • 3.8 million adults are eligible for Medicare or marketplace subsidized coverage.
  • 5.3 million are eligible for tax credits on the ACA exchanges.
  • 4.5 million people are ineligible for financial assistance on the marketplace since their employers sponsor their coverage, but they evidently choose not to purchase coverage.
  • 2.5 million people fall in the coverage gap.
  • Approximately 5.4 million are banned from getting coverage because of their immigration status.
  • Another 3 million are ineligible for both Medicaid and marketplace financial assistance because of annual income.

Further, a recent Department of Health and Human Services analysis estimated 2.5 million people who purchase off-exchange coverage could be eligible for financial assistance if they were to enroll through the ACA marketplace, FierceHealthPayer reported.