26 States With a Big Health Coverage Gap


This week, Health Insurance Marketplaces opened in states across the country.  It's true: Many more Americans will now have access to affordable health care.  But, other hard-working people, who live in states that have not yet committed to expanding Medicaid, will fall into a new coverage gap.

That's right: In the 26 states that have not accepted federal funding to expand Medicaid, adults who earn up to $15,000 a year will not qualify for any type of subsidy through the Health Insurance Marketplace, while their friends or neighbors with slightly higher incomes (between 100 and 400 percent of the federal poverty level) may have access to financial help.

These states have not expanded Medicaid: Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

Pennsylvania: 500,000 Residents Without Health Coverage

There has been some movement in Pennsylvania recently when Gov. Tom Corbett announced his willingness to expand health care coverage for citizens in the state through a private insurance model and a reformed Medicaid program. However, AARP has advocated for a stronger Medicaid program by supporting language passed by the state senate in June and legislation that will be introduced by Senator Pat Vance this fall.

   "We agree with the governor that Pennsylvania must act now to improve access to health coverage, ensure quality, and improve affordability."- Bill Johnston-Walsh, AARP Pennsylvania

Expanding Health Coverage in Pennsylvania will:

  • Keep 500,000, including 90,000 ages 50-64, Pennsylvanians from falling into a coverage gap.
  • Create 35,000 jobs.
  • Result in $3.6 billion in tax revenues.
  • Create $4.4 billion in savings over the next 10 years.

Meanwhile, Centers of Medicare and Medicaid Services (CMS) has approved a health care expansion waiver for Arkansas, and is in the process of reviewing Iowa's waiver - both approaches would work with private insurers to close their coverage gap.  But, the overarching goal remains to provide affordable and accessible health coverage to adults who earn up to $15,000.

Another state still weighing its decision is New Hampshire.  In April, Gov. Maggie Hassan created a commission to study Medicaid Care Management.  A report from the commission is expected this month.

If Medicaid Expansion passes in New Hampshire it will:

  • Decrease New Hampshire's uninsured population by 52.3 percent.
  • Provide health coverage to 13, 876 ages 45 to 64, including those with chronic conditions such as hypertension and diabetes.
  • Provide access to important and potentially lifesaving preventive and screening services.

Claira Monier, a volunteer with AARP said it simply,

"I believe Medicaid expansion will save lives,"

And, kudos are in order for Michigan, where Gov. Rick Snyder recently signed the Healthy Michigan Legislation into law, in essence, expanding Medicaid.  The law will:

  • Provide health care coverage to 470,000 uninsured Michiganders.
  • Enable Michigan residents with incomes up to $15,000 to qualify for health coverage under Medicaid.
  • Establish Michigan-specific reforms to ensure cost-effectiveness and better health outcomes.
  • Decrease Michigan's uninsured population by 55.5 percent.

I will be keeping a close eye on Pennsylvania, New Hampshire - and also, Ohio, another state where the Medicaid expansion debate continues.  Follow me on Twitter @RoamTheDomes for more on this important issue. And, to stay up-to-date on our Medicaid expansion campaign in the states, sign up for the AARP Advocate newsletter or visit your state Web page.


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