Affordable Care Act Coverage Gap App


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 Kaiser Foundation's recently released chart tracks this coverage gap. It allows readers to click through a map of the United States and see, on a state by state basis, how many people are eligible for insurance subsidies, how many are eligible for Medicaid and how many fall through the cracks.

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.

Kaiser projects that Florida will have the second largest gap, with 764,000 people falling in between federal subsidies and the state cutoff for Medicaid at $8,197 per year for a family of four.

Many of the states which have accepted the federal expansion of Medicaid already offered the program for parents up to 100% of the poverty level, the point at which premium subsidies kick in. Most of the states which have not accepted the expansion offer far less, however, with a median eligibility level at 47% of the poverty line for parents. This is considerably less in some states with the lowest being Alabama, which cuts off access to Medicaid at $3,221 per year.

Wisconsin alone, out of the states which have rejected the federal expansion of Medicaid, will not have a gap in health insurance coverage.

--Written for MainStreet by Eric Reed, a freelance journalist who writes frequently on the subjects of career and travel. You can read more of his work at his website

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