Two in every five adults who have recently been uninsured living in states that have not yet decided to expand Medicaid eligibility under the Affordable Care Act would likely have no new affordable health insurance options if their states don't eventually expand the program, according to a report released Wednesday.
The U.S. Supreme Court ruled in 2012 that the federal government cannot require states to expand Medicaid eligibility. Oklahoma and roughly 25 other states have said they will not, or may not, expand their Medicaid programs in 2014.
In these states, the lowest-income adults, those earning below the federal poverty level — or less than $11,170 for an individual and $23,050 for a family of four in 2012 — will not have access to either the Medicaid expansion or subsidized private insurance through the new state insurance marketplaces and could remain uninsured, according to the report from the Commonwealth Fund.
The report, based on a survey of U.S. adults ages 19 to 64, found that an estimated 55 million Americans were uninsured for all or part of the time from June 2010 to September 2012. In the states that have not yet decided to expand Medicaid, 72 percent of adults whose incomes fell below 133 percent of the federal poverty level during the two-year period had spent some time uninsured.
Under the Affordable Care Act, starting in 2014, people earning less than 133 percent of the federal poverty level will qualify for Medicaid. But because of the way the law was written, people making between 100 percent and 133 percent of the federal poverty level are eligible to purchase subsidized insurance coverage through the state marketplaces if they are not eligible for Medicaid.
However, people making less than 100 percent of the poverty level are not eligible for marketplace subsidies, since it was assumed that they would be enrolled in Medicaid and lawmakers did not anticipate the Supreme Court decision.