Coverage gap in La. affects nearly a quarter-million
Eighty-seven percent of Louisiana’s poor, uninsured, non-elderly adults will fall within a health insurance coverage gap because the state did not expand Medicaid with the federal health care revamp, according to the Kaiser Family Foundation report released Wednesday.
The percentage translates into 242,150 individuals who have incomes above the state Medicaid program’s eligibility levels but not enough to qualify for tax credits in the marketplace insurance exchanges, the analysis found.
About 5.2 million poor, uninsured adults who would fall in the “coverage gap” live in the 26 states that have opted not to participate in the Medicaid expansion provided in the federal Affordable Care Act, according to the Kaiser Commission on Medicaid and the Uninsured, a foundation that studies healthcare issues. A fifth of those people live in Texas. Fifteen percent in Florida.
“The ACA envisioned people below 138 percent of poverty receiving Medicaid and thus does not provide (insurance) premium tax credits for the lowest income,” the Kaiser report states.
“As a result, the individuals below poverty are not eligible for Marketplace tax credits, even if Medicaid coverage is not available to them.”
For a single adult in 2014 when the program starts, 138 percent of poverty would be an income of $15,856.
Gov. Bobby Jindal rejected Louisiana participation contending it would become too costly over time for the state, and it would build on a broken health care system.
The expansion would be 100 percent federally funded for the first three years, then the federal share would drop to 90 percent.
State health agency chief of staff Calder Lynch said the Kaiser report number is a little higher than the 214,000 individuals the state has estimated would fall into that noncoverage category.
Lynch said the administration is confident those who fall in the insurance coverage gap will be able to access health care.
“These are individuals who have access to our safety net system through LSU and its (hospital) partnerships,” said Lynch. In addition, he said there are also community resources such as Federally Qualified Health Centers.
“There’s a robust network available to them. That network is growing stronger,” he said, noting that clinics are being expanded at the privatized public hospitals to serve more people.
Lynch said the expansion would have added three times as many people to the Medicaid rolls and brought some 171,000 people off private insurance into Medicaid.
He said expansion was not “a sustainable solution” for Louisiana.
The Kaiser report concluded that people in the coverage gap are likely to face barriers to needed health care services, “or if they do require medical care, potentially serious financial consequences.”
“Further, the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be stretched in these states,” the report states.
Many people will be left without an affordable coverage option and Medicaid eligibility for adults in states that do not expand Medicaid is limited, according to the report.