Half of America's remaining uninsured are eligible for health coverage

By Bob Herman
October 13, 2015 - Modern Healthcare

Almost half of the 32.3 million nonelderly people who have no health insurance could gain coverage through their state's existing Medicaid policy or a subsidized exchange plan, according to a survey from the Kaiser Family Foundation.

The federal government is hoping those uninsured will sign up for coverage during the Affordable Care Act's upcoming open enrollment. The Congressional Budget Office estimates 33 million people will have a health plan through Medicaid, the Children's Health Insurance Program or the exchanges by 2016, a large jump from the current 17.6 million people who have become insured under the ACA.

Under the ACA, people earning up to 400% of the federal poverty can shop for health insurance on state and federal marketplaces, and part of their monthly premium could be subsidized through tax credits. The law also allowed states to expand Medicaid to low-income earners who made up to 138% of poverty, although several Republican states have not taken that option.

The Kaiser Family Foundation, a not-for-profit healthcare think tank, said 15.7 million people are eligible for financial assistance through Medicaid or the exchanges, but simply haven't gotten the coverage. Reasons vary for why some remain uninsured, though a lack of education and awareness of their options is considered a top cause. Others are confused about their eligibility, while many believe health plans are still too expensive even with subsidies, the foundation said.

Almost 8.6 million people could sign up for a state Medicaid program, many of which are in the highly populated states that expanded Medicaid, including California and New York. Thousands of people living in states that haven't expanded Medicaid, such as Texas and Florida, are estimated to be eligible for the program but don't have coverage.

The remaining 7.1 million people in the foundation's tally are eligible for subsidized health plans. Approximately 41% of them reside in four states: Texas, Florida, California and Georgia.

The other half of people who don't have health insurance are not eligible for any kind of subsidies or financial help. Many are undocumented immigrants or people who fall in the so-called Medicaid “coverage gap.” Those in the coverage gap live in states that didn't expand Medicaid, and they earn too much for Medicaid but not enough to qualify for exchange subsidies.

Kaiser analysts used data from the U.S. Census Bureau for its report. The Census Bureau said in September that 33 million people, or about 10.4% of all Americans, had no health insurance in 2014.