The Affordable Care Act enabled states to expand their Medicaid programs to include millions of low-income adults, but as of today 14 states have declined to do so (see this tracker for more details on state expansions.)
As a result, 2.3 million people in those non-expanding states fall into a Medicaid “coverage gap” in which they earn too much to qualify for Medicaid but not enough to receive tax credits in the Obamacare marketplaces. A new analysis by the Kaiser Family Foundation explains that, “because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options."
Who falls in through that crack? “By definition, people in the coverage gap have limited family income and live below the poverty level,” the Kaiser analysis says. “They are likely in families employed in very low-wage jobs, employed part-time, or with a fragile or unpredictable connection to the workforce. Given limited offer rates of employer-based coverage for employees with these work characteristics, it is likely that they will continue to fall between the cracks in the employer-based system.”
As the chart below shows, more than 90% of those falling into the Medicaid gap live in the South, and a third live in just one state, Texas.