By Rebecca Adams, CQ HealthBeat Associate Editor
July 18, 2013 -- About 6.4 million people will not become insured next year unless officials in the 27 states that have not committed to expanding Medicaid change their minds, according to a new analysis released the Kaiser Commission on Medicaid and the Uninsured released Thursday.
The analysis, produced by the Urban Institute for the Kaiser commission, found that nearly two-thirds of those who were originally expected to be covered by the Medicaid expansion live in the 21 states that are not expected to expand as of Jan. 1 and the six states that are still debating the issue. Framers of the health law (PL 111-148, PL 111-152) had counted on a nationwide Medicaid expansion to take care of a large proportion of the uninsured. But last year’s Supreme Court decision validating the health law also ruled that states would not lose their base Medicaid reimbursements if they didn’t expand, effectively giving states the choice of whether to broaden Medicaid eligibility.
Texas, Florida and Georgia are among the states that decided not to expand. The uninsured in those states account for 55 percent of those in the 27 states not expanding who would not have the opportunity to get coverage, the 24-page report says. Because of the way the overhaul subsidies are constructed, people with incomes who would have qualified for the expanded Medicaid, may not be able to get federal help to buy insurance. Without such help, most are unlikely to be able to afford to health insurance.
The 21 states that are not planning to broaden Medicaid eligibility at this time would miss out on the chance to get $35 billion in federal funds in 2016, the analysis said, and the six states still currently debating would forgo $15.2 billion that year if they don’t extend the program before then. The analysis did not estimate what those states would lose in 2014 and 2015.
A separate 10-page issue brief Kaiser also released Thursday found that more than 8 in 10 uninsured people who would qualify for Medicaid if their state broadened their Medicaid program, live in states that are currently not pursuing an expansion. Throughout the nation, nearly half of the uninsured with incomes below the Medicaid expansion income leve —138 percent of federal poverty—live in states that do not plan to increase eligibility. None of the states that have decided to skip expansion currently cover adults without children.
The decisions by state officials to avoid expansion will significantly impact minorities, the brief found. About 47 percent of all uninsured minorities who have annual incomes of less than 138 percent of poverty live in states that are not expanding.
Rebecca Adams can be reached at [email protected].