NEW YORK (MainStreet) A new map by the Kaiser Foundation charts the Affordable Care Act coverage gap, allowing users to see how the new law might change the insurance landscape next year.
When Congress passed the ACA it added two major features to help defray the cost of health insurance: premium subsidies paid through tax credits and a federal expansion of Medicaid. The expansion of Medicaid, in the states which accept it, sets eligibility for the program at 138% of the federal poverty level: $15,856 for an individual and $32,499 for a family of four.
Some states have chosen to reject this expansion of the Medicaid program however, pushing many people into what's become known as the "coverage gap."
According to a Kaiser brief, "In states that do not expand Medicaid, nearly 5 million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a 'coverage gap' of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits."
The single largest crisis is in Texas, which will have an anticipated 1,046,000 residents fall into the coverage gap next year. Under Texas law an average family of four must earn less than $4,501 per year in order to qualify for assistance under Medicaid. Adults with no children can't qualify under any circumstances. Tax credits on the ACA exchanges would not kick until $23,550, meaning that even a single adult, employed full time, might not be able to get health insurance until he earns more than $11 per hour.