As of , Medicaid had been expanded in 38 states and the District of Columbia see list below. Oklahoma and Missouri are the most recent states to have expanded Medicaid, both doing so in But Wisconsin is not counted among the Medicaid expansion states. It has implemented what essentially amounts to a partial expansion of Medicaid, and has no coverage gap described below because Medicaid is available to low-income adults with income below the poverty level.
The federal government is financing most of the cost of expanding Medicaid, and a small portion is being paid by participating states. As noted above, the federal government does not provide this funding unless a state fully expands Medicaid. So Wisconsin continues to receive its normal federal match for Medicaid funding, and Utah was unable to secure Medicaid expansion funding until Medicaid was fully expanded Utah initially implemented a partial expansion of Medicaid, but did not receive enhanced federal funding for it.
How many people are enrolled in coverage due to Medicaid expansion? To be clear, this is due to the decisions that their states have made, rather than a flaw in the ACA itself.
The states could opt to accept federal funding to expand Medicaid at any time, thus closing the coverage gap. For people in the coverage gap who received unemployment compensation for at least one week in , the American Rescue Plan provided eligibility for premium subsidies.
But this was a temporary provision for The Build Back Better Act, which is the subject of considerable debate in Congress in the fall of , includes a provision to extend that unemployment-based subsidy benefit for And crucially, it would also provide federal subsidies for four years to people in the coverage gap , allowing them to purchase premium-free coverage with enhanced benefits that leave them with very little out-of-pocket costs.
More than a third of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility Figure 2. Nineteen percent of people in the coverage gap live in Florida, twelve percent in Georgia, and ten percent in North Carolina. There are no uninsured adults in the coverage gap in Wisconsin because the state is providing Medicaid eligibility to adults up to the poverty level under a Medicaid waiver. The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state take-up of the ACA Medicaid expansion.
The South has relatively higher numbers of poor uninsured adults than in other regions, has higher uninsured rates and more limited Medicaid eligibility than other regions, and accounts for the majority 8 out of 12 of states that opted not to expand Medicaid.
If states that are currently not expanding their programs adopt the Medicaid expansion, all of the nearly 2.
In addition, 1. Though most of these adults are eligible for substantial tax credits to purchase Marketplace coverage, 7 Medicaid coverage would likely provide more comprehensive benefits and lower premiums or cost-sharing than they would face under Marketplace coverage. For example, research from early implementation of the ACA showed that coverage of behavioral health services, prescription drugs, rehabilitative and habilitative services, and long-term services and supports may be more limited in the Marketplace compared to Medicaid.
A smaller number about , of uninsured adults in non-expansion states are already eligible for Medicaid under eligibility pathways in place before the ACA.
If all states expanded Medicaid, those in the coverage gap and those who are instead eligible for Marketplace coverage would bring the number of nonelderly uninsured adults eligible for Medicaid to more than 4. The potential number of people who could be reached by Medicaid expansion varies by state Table 1.
The ACA Medicaid expansion was designed to address historically high uninsured rates among low-income adults, providing a coverage option for people with limited access to employer coverage and limited income to purchase coverage on their own. In states that expanded Medicaid, millions of people gained coverage, and the uninsured rate dropped significantly as a result of the expansion.
Yet a majority of people in the US—Democrats, Republicans, and independents alike—believe that the program is working well. Most Medicaid enrollees are quite happy with their coverage, reporting higher rates of satisfaction than people with private insurance. Furthermore, in states that have not expanded Medicaid, a clear majority favor doing so. And, as noted, there is clear evidence that Medicaid coverage leads to substantial improvements in health and financial well-being.
The Urban Institute has estimated that if all states adopted Medicaid expansion, 4. Dr Cliff reported other from CMS. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details. The Benefits of Medicaid Expansion.
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Save Preferences. Privacy Policy Terms of Use. Twitter Facebook. This Issue. Views 7, View Metrics.
July 15, Thomas C. Buchmueller, PhD 1 ; Betsy Q. Editor's Comment. Back to top Article Information. Medicaid expansion and the unemployed.
0コメント