Momentum Builds to Close Health Coverage Gap


When you’re sick, what do you do?

A. Nothing,
B. Call a doctor, or
C. Go to the E.R.?

Every day, millions of hard-working Americans who have lost their jobs or are struggling in jobs without health coverage choose A. Nothing. That is, until their condition gets so bad they are forced to choose C. and go to the ER. Without affordable health coverage, paying for a doctor’s appointment is just too expensive, and the necessities of daily living like rent and food take priority.

That’s why 27 states and the District of Columbia have taken action to expand Medicaid — and provide access to affordable health coverage to their hard-working residents who earn up to $16,000 a year.

Keystone State Creates Momentum

Pennsylvania is the most recent state to expand affordable health coverage through Healthy Pennsylvania, an alternative plan to provide coverage through the private sector, now approved by the Centers for Medicare and Medicaid Services (CMS). While AARP still has some concerns about the plan — and fought hard over the last two years to make it better — when Healthy Pennsylvania goes into effect on Jan. 1, about 500,000 hard-working Pennsylvanians, including many ages 50-64, will have access to the health coverage they need so they can go to the doctor when they are sick.

>> 8 Things You Need to Know About Medicare

The action by Pennsylvania may now create some much-needed momentum for other states to advance plans to expand Medicaid in alternative ways. Closing the New Coverage Gap Keep in mind: Millions of Americans still don’t have access to affordable health care since they fall into what is called the new coverage gap. This means they:

  • Live in one of the 23 states that have not yet decided to expand Medicaid, a key component of the Affordable Care Act, implemented at the state level.
  • Earn too much to qualify for Medicaid under the current requirements — up to $16,000 a year.
  • Ironically, earn too little to receive subsidized coverage through the Health Insurance Marketplace, even though those making slightly more may have access to financial assistance to help pay for health care.
  • Are too young to qualify for Medicare.

Which state will be next?

  • Richard J., age 61, lives in Utah, one of the 23 states that have not expanded affordable health coverage. Richard worked hard in construction but now suffers from degenerative joint disorder. Earning too much to qualify for Medicaid and too little to get help in the Health Insurance Marketplace, Richard falls into this coverage gap. He says, “Health insurance means security.”

Here is what affordable health care in Utah would mean for Richard and tens of thousands of other Utahans:


  • Indiana: An alternative plan to expand access to affordable care in Indiana is being reviewed by the CMS. If approved, the plan will give more than 180,000 Hoosiers access to affordable care.
  •  Tennessee: Gov. Bill Haslam has announced that the state will soon submit a plan for alternative Medicaid expansion to CMS. Such a plan could expand access to affordable care to 160,000 hard-working Tennesseans.

Click here to see where your state stands

>> Get discounts on health services with your AARP Member Advantages.

I will be keeping a close eye on the states working to expand affordable health coverage — and AARP will keep fighting to make sure residents in every state have a way to get out of the new coverage gap. Follow me on Twitter @RoamTheDomes for more on this important issue. And, to stay up to date on Medicaid expansion in the states, sign up for the AARP Advocate newsletter or visit your state Web page.