Medicaid opt-out states would benefit most from insurance reforms

Thirty-two million Americans under the age of 65 remained underinsured in 2012, a new state-by-state analysis from the Commonwealth Fund finds. These individuals had health coverage, but still spent 10 percent or more of their income on medical costs, or 5 percent or more for those with low incomes.

The Affordable Care Act's Medicaid expansion targets Americans who are most likely unable to afford insurance. Based on their incomes, 20 million of the underinsured, and 24 million of the uninsured in 2012 would qualify for Medicaid. In states choosing to not expand Medicaid, more than 15 million underinsured and uninsured earn less than $23,550 a year for a family of four, placing them below the poverty line.

"The vast majority of people struggling to afford healthcare are low- and middle-income, and exactly the people the Affordable Care Act was designed to help," Commonwealth Fund Senior Vice President Cathy Schoen and lead author of the report said today in a statement.

About 13 percent of the underinsured have middle incomes, earning between $47,000 and $95,000 for a family of four, and 81 percent have low incomes, earning less than $47,000 a year for a family of four, according to the Commonwealth Fund.

"This report demonstrates that the health reform law was accurately targeted toward the needs of the uninsured and underinsured. However, if all states don't expand Medicaid, millions will still go without health insurance and healthcare," Schoen said.

The report also found  the ACA would help individuals with high insurance costs. In 2012, 29 million people with coverage paid more out-of-pocket for their premiums than they would have to pay if they were eligible to participate in Medicaid.

Uninsured rates have been falling as millions continue to sign up for either marketplace coverage options or Medicaid. The most recent health insurance exchange enrollment data suggests the marketplaces are on track to sign up 5.4 million people--falling just short of the government's prediction of 6 million.

For more:
- here's the Commonwealth Fund announcement
- here's the full report (.pdf)

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