'Coverage gap' likely to affect 5.2 million uninsured adults

(HealthDay)—About 5.2 million uninsured adults are expected to fall into the Affordable Care Act (ACA) 'coverage gap,' with incomes too high to qualify for Medicaid programs but below the level eligible for federal subsidies to purchase private insurance, according to a report issued by the Henry J. Kaiser Family Foundation.

Although the ACA provides full federal funding for three years to states that expand Medicaid to cover residents under 138 percent of the poverty level, most Republican-led states (26 states in total) have opted against expansion.

Based on census data from 2012 and 2013, and state Medicaid eligibility rules for 2014, the report estimates that 5.2 million poor, uninsured adults will fall into the 'coverage gap,' with incomes too high to qualify for existing Medicaid programs but below the federal poverty level required to be eligible for subsidies to buy private coverage through the insurance marketplaces. Almost half of the uninsured live in Texas, Florida, and Georgia. More than one-third of adults from Alabama, Mississippi, and Louisiana will fall into the coverage gap, and nationwide, more than one-quarter (about 27 percent) of uninsured adults in states not expanding Medicaid will fall into the gap.

"Millions of adults will remain outside the reach of the ACA and continue to have limited, if any, options for health coverage," the report concludes.

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