Twenty-three states aren’t expanding Medicaid. Here’s who they leave behind.

December 17, 2013

Twenty-three states are currently not planning to move forward with the Medicaid expansion, which was meant to cover millions of low-income Americans. The population they leave behind is mostly young, minority, single adults, according to two new data briefs from the Kaiser Family Foundation.

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Their analysis is one of the most in-depth looks at the population that falls into this coverage gap, too poor to qualify for insurance subsidies (those are available only to those who earn above the poverty line, about $12,000 for an individual). They're also shut out of the traditional Medicaid program, which tends to cover low-income parents, children and those with disabilities.

Kaiser estimates that approximately 4.8 million people will fall into this no man's land of health-care reform, where they do have the option to purchase private insurance on the individual market -- but would have to do so without any financial help from the government.

Three-quarters of those who will fall into this coverage gap are adults who do not have children. As Kaiser notes, this reflects the limitations on the current Medicaid program. While some states do use the publicly-funded program to cover low-income, single adults, that's the exception rather than the rule. Nine states currently offer coverage to adults, with income limits that range from 10 to 200 percent of the poverty line ($1,1490 to $22,980, respectively).


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The coverage gap population is majority minority: 53 percent of those left without financial assistance are either African American, Hispanic or another non-white ethnicity. Most of them have jobs. Of the 4.8 million people estimated to be in the coverage gap, 2.6 million are working either full- or part-time. Among those working, half are in the agriculture industry. Most work for businesses with fewer than 100 employees, which tend to be less likely to offer insurance coverage.They skew younger and healthier. Half are under 35; three-quarters describe themselves as being in good, very good or excellent health.

If there's any silver lining to this data set, it does suggest that those in the Medicaid gap are, from their self-reporting, in better health and potentially in less need of health care. That obviously doesn't protect against catastrophic events that have little to do with an individual's current health. The health-care law was supposed to offer such protection, but -- for these millions of Americans -- now it won't.

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Evan Soltas | December 17, 2013