Who falls into the Medicaid Expansion Gap in PA?

5 million low-income people. That’s how many Americans are in the Medicaid Expansion Gap – people the Affordable Care Act (aka “Obamacare”) was originally designed to cover but isn’t. In Pennsylvania? 281, 290 uninsured nonelderly adults.

In addition to a host of policies to improve the quality and availability of health insurance, the Affordable Care Act primarily aims to improve health coverage, well, affordability. It does this by providing tax credits to households living at 100-300% of poverty to help them purchase private health insurance.

The hard numbers

Medicaid, known as Medical Assistance (MA) in Pennsylvania, is a federally-funded medical insurance program that generally covers low-income households with children, seniors, and people with disabilities. Pennsylvanians must be extremely poor to qualify for MA, living well below the poverty line – below 33% of the poverty level (see chart below) for adults with children, for example. Medicaid Expansion Gap 2013 FEDERAL POVERTY LEVELS / AFFORDABLE CARE ACT ELIGIBILITY Family / Household Size 33% 100% 138% 300% One $3,792 $11,490 $15,856 $34,470 Two $5,118 15,510 21,404 46,530 Three $6,445 19,530 26,951 58,590 Four $7,772 23,550 32,499 70,650 For each additional person, add $4,020/year ($335/month) for families at 100% of poverty. Obamacare provides tax credits to help people who are at 100%–300% of poverty level purchase health insurance. It also would expand Medicaid to cover anyone below 139% if the state agrees. Without Medicaid Expansion, anyone at 33%-139% of poverty will be uninsured. If Gov. Corbett accepts Medicaid Expansion, those at 0-100% of poverty would have Medicaid and at 100-139% of poverty would have the choice of Medicaid or tax credits to purchase private insurance.

However, many are still left out of the Affordable Care Act because they make too little to qualify for those tax credits. They’re in between the rock and a hard place of making too much to qualify for Medicaid – government health coverage for the poorest of the poor – but too little to get help purchasing health insurance.

The Affordable Care Act originally had a plan to deal with the millions of uninsured in this gap: require states to either expand Medicaid on the federal government’s dime to cover all those below 139% poverty or submit some other plan to cover the uninsured (though at a lower federal reimbursement rate). Medicaid expansion would have covered 10.2 million uninsured Americans.

Following Republican party efforts to stop “Obamacare” roll-out, the Supreme Court ruled in 2012 that the Affordable Care Act is constitutional but that the Medicaid expansion component should be optional. States can now simply opt out of Medicaid expansion.

For no apparent reason other than politics, that is what PA has done.

Governor Corbett has so far refused to take federal funding to expand Medicaid eligibility to cover uninsured Pennsylvanians. Instead, he has submitted to the federal government a plan – Healthy PA – to use those Medicaid dollars in a different coverage scheme. (The plan would have to be approved by federal reviewers.)

Unfortunately, many of those currently uninsured will still be uninsured under Healthy PA – either due to income cut-offs or because they can’t afford the premiums that the private insurers the state would contract with will charge.

In addition, thousands of workers with disabilities will actually lose their coverage under Healthy PA, which ends MAWD (Medical Assistance for Workers with Disability).