Number who fall into gap
A list of the states not expanding Medicaid under the 2010 federal health care law and the number of residents who will fall in to a health care gap between the current Medicaid eligibility guidelines of their state and the tax credits available under the law to help people pay for private insurance.
TOTAL — 4,831,590
Alabama — 191,320
Alaska — 17,290
Florida — 763,890
Georgia — 409,350
Idaho — 54,780
Indiana — 181,930
Kansas — 77,920
Louisiana — 242,150
Maine — 24,390
Mississippi — 137,800
Missouri — 193,420
Montana — 40,140
Nebraska — 32,570
New Hampshire — 26,190
North Carolina — 318,710
Oklahoma — 144,480
Pennsylvania — 281,290
South Carolina — 194,330
South Dakota — 25,480
Tennessee — 161,650
Texas — 1,046,430
Utah — 57,850
Virginia — 190,840
Wisconsin — 0
Wyoming — 17,390
— Associated Press
About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America.
They make up a coverage gap in President Barack Obama’s signature health care law created by the domino effects of last year’s Supreme Court ruling and states’ subsequent policy decisions.
The court effectively left it up to states to decide whether to open Medicaid, the federal-state program for the poor and disabled, to more people, primarily poor working adults without children.
Twenty-five states declined. That leaves 4.8 million people in those states without the health care coverage that their peers elsewhere are getting through the expansion of Medicaid, according to a Kaiser Family Foundation estimate. More than one-fifth of them live in Texas alone, Kaiser’s analysis found.
Among those in the gap is Shelagh Collins of Pittsburgh. Collins can get primary care at a federally funded community health center nearby, but she can’t afford more specialized treatment for her joint aches and pains that limit her ability to do certain jobs, she said.
Collins, 56, used to be a high-level administrative assistant at the Chicago Botanic Garden. Now she gets by on occasional secretarial temporary work and unemployment compensation checks and is trying to protect a 401(k) retirement account of $21,000 that she said makes her ineligible for Pennsylvania’s current Medicaid program.
But the job market is brutal, temp work is scarce and her unemployment compensation checks are at an end, she said.
“I have never gone through anything like this in my life,” Collins said.
The Medicaid expansion was supposed to work hand-in-hand with tax credits subsidizing private insurance for people with slightly higher incomes, two keys to the law’s broader aim of extending health insurance to 30 million more people. As an enticement for states to expand Medicaid, the federal government promises to pay nearly all of the cost.
Without the expansion, the law is unable to help people who are below the income threshold where tax credits start kicking in, about $11,500 for working adults.
On Wednesday, 24 states and Washington, D.C., will extend Medicaid to more than 4 million adults who would otherwise fall into the same gap as Jones. Access to the care they’ll get is similar to what people get with private insurance, said Joan Alker, executive director of Georgetown University’s Center for Children and Families.
A 25th state, Michigan, plans to expand in April. Wisconsin effectively eliminated its own gap without using the more generous federal contribution.
Pennsylvania Gov. Tom Corbett, a Republican who sued unsuccessfully as attorney general to overturn the health care law, plans to ask the federal government to approve an alternative to a Medicaid expansion. He wants to use the law’s generous Medicaid dollars to cover the same population through private insurance companies while stripping down existing benefits under Medicaid.
With no guarantee of federal approval, hundreds of thousands of Pennsylvanians — Kaiser estimates 281,000 — could be stuck in the gap until at least 2015.
Corbett doesn’t apologize for not expanding eligibility right away. Rather, administration officials say they want to put themselves in a better position to create a successful, affordable program.
“Our goal is to absolutely get this plan approved so that every uninsured Pennsylvanian has health care options,” said a senior Corbett aide, Todd Shamash. Corbett’s office declined to make him available for an interview.
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