According to a report released by the Urban Institute on June 29, 2012, many low-income Americans may remain uninsured in states that do not choose to implement the Medicaid expansion under the Affordable Care Act (ACA). This is a result of the Supreme Court’s June 28, 2012 ruling which made the expansion of Medicaid coverage to nonelderly adults with incomes below 138 percent of the federal poverty level optional for states.
According to the report, which is based on estimates from the 2010 American Community Survey on the number of non-elderly people who could be covered by Medicaid under the ACA, there are approximately 22.3 million uninsured people who could qualify for Medicaid by having incomes below 138 percent of the Federal Poverty Level. Eighty percent of these 22.3 million, or approximately 17.8 million of these Medicaid eligible uninsured individuals, have incomes below the poverty level.
If a state does not implement the ACA’s Medicaid expansion, some people who would have received Medicaid could instead receive federal tax credits and other subsidies, but cost-sharing requirements would be higher than they would have been under Medicaid. Federal tax credits and subsidies, however, would not be available for most of the 17.8 million people with incomes below the federal poverty level, leaving them at risk of remaining uninsured.
At this time, it is not clear whether and how many states will choose to expand Medicaid up to 138 percent of the federal poverty level as allowed by ACA. Twenty-seven states challenged the constitutionality of the Medicaid expansion. In addition, in the wake of the Supreme Court’s decision, some governors have indicated they may not implement Medicaid expansion.
To view a complete copy of the report, please click here.