New Health Care Coverage Gap


Meet Lorna, a 59-year-old who has been unemployed for a year and, as a result, doesn't have health insurance. She has Type-2 Diabetes.  Recently she had to have some blood tests done, costing $600 that she can't afford.  She has a broken tooth that she's not able to get fixed.  She wants to work, but can't find a job in the area.

Meet a 60-year-old woman whose husband retired in 2010 and, as a result, she lost her health insurance coverage. The couple couldn't afford the $650 per month that it would cost to continue her coverage.  In August of last year, she was diagnosed with breast cancer, and had to have surgery that cost $32,000.  The provider discounted the bill by 60 percent.  Still, the only way she can pay for some of the cost is by charging it to a credit card.

  What do these women have in common? They lack access to affordable health care because:

  • They live in Nebraska, one of about 27 states that have not yet chosen to expand Medicaid to cover all adults earning incomes up to 138 percent of the federal poverty level - about $15,000 a year or less.
  • They don't qualify for Medicaid under the current requirements. While states differ, those that chose not to expand Medicaid cover only those adults with children below a certain income level, as well as pregnant women, some seniors and people with disabilities.
  • They are too young for Medicare, which starts at age 65.
  • Ironically, they are too poor to qualify for subsidies to purchase health insurance through the health care exchanges; only those with incomes between 100 and 400 percent of the federal poverty level qualify for federal assistance.

If Nebraska expanded Medicaid coverage, Lorna and the 60-year-old woman fighting breast cancer would have health insurance coverage. Under the health care law, individuals with incomes up to 138 percent of the federal poverty level could be covered with Medicaid. But, if states refuse to expand Medicaid, the poorest citizens will fall into the new "coverage gap" - and an estimated 4 million adults age 45-64 who are currently uninsured will remain without health coverage.

You may also be interested in: 5 Reasons to Care about Medicaid Expansion

What would happen if these states expand Medicaid, and the gap closes?

  • Florida would see a 48.3 percent decrease in its uninsured population.
  • Michigan would see a 55.5 percent decrease in its uninsured population, including coverage for 75,000 state residents between ages 50 and 64.
  • Nebraska would see a 51.1 percent decrease in its uninsured population, including coverage for 19,000 Nebraskans between the ages of 45 to 64.
  • New Hampshire would see a 52.3 percent decrease in its uninsured population.
  • Ohio would see a 55 percent decrease in its uninsured population, resulting in coverage for 275,000 Ohioans, including 26,000 veterans and low-wage workers whose jobs don't provide health insurance.
  • Pennsylvania would see a 54 percent decrease in its uninsured population, resulting in coverage for 542,000 uninsured residents by 2022 at no cost to the state for the first three years and no more than 10 percent of the cost in the future.
  • Tennessee would see a 51.9 percent decrease in its uninsured population, 22,000 new jobs, more than $577 million in local and state tax revenue, and more than 77,000 residents between the ages of 50 and 64 would be eligible for affordable health care.

Find out what would happen in your state.

Follow me on Twitter @RoamTheDomes for more on the new coverage gap.  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.

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