By Miriam Harmatz, Alison Yager, and Matt Childers
BACKGROUND ON MEDICAID EXPANSION
The Affordable Care Act (ACA or Obamacare) provided two “paths to coverage” for people with low to moderate incomes. First, people with moderate incomes (100 to 400% of the federal poverty level) could receive subsidies to help pay for insurance in the new Healthcare Marketplace. Second, the law provided that very low-income, uninsured adults between the ages of 19 and 65 would get health care coverage through an expanded Medicaid program, to be largely paid for by the federal government. The expansion extended coverage to adults below 138% of the federal poverty level (FPL) and eliminated Medicaid’s “categorical requirement,” which limited adult coverage to pregnant women, parents and people who were aged, blind or disabled. Although Medicaid expansion was meant to be national in scale, the Supreme Court ruled in 2012 that the federal government could not force states to expand their Medicaid program, but rather expansion must be a state “option.”
STATUS AND IMPACT
Florida is one of only 14 states that have not expanded Medicaid. As a result, approximately 445,000(1) Floridians fall into the “Coverage Gap,” meaning they have no path to affordable coverage. For example, a working parent with one child who earns just $500/month (35% of the Federal Poverty Level) is above the income threshold, and therefore ineligible, for Florida’s very limited Medicaid coverage, and at the same time is below the income cut-off for, and therefore unable to purchase, Marketplace coverage. Additionally, approximately 392,000(2) low-income Floridians who do qualify for Marketplace insurance (those between 100 and 138% FPL) are severely burdened by out-of-pocket costs and challenges in accessing care, many of which would be resolved with Medicaid expansion.
A large body of data and evidence show that those states which have chosen to expand Medicaid under the ACA have witnessed improved healthcare access and individual financial stability, as well as economic benefits for states, local communities and providers.
Until Florida expands Medicaid, policy makers and the public must hear from uninsured residents about the suffering and loss that comes with lacking health coverage. The Florida Health Justice Project is working with impacted individuals, advocates and health care providers to help bring these stories to light through our Florida Health Justice STORIES initiative.
1 Garfield, Rachel, Kendal Orgera, and Anthony Damico. 2019. “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” Issue brief. Washington, D.C.: Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.