What is Medicaid Expansion? Under the Affordable Care Act (ACA), Medicaid was expanded to provide health insurance coverage to low-income uninsured adults aged 19-64. The Supreme Court ruled that each state should decide whether or not to expand Medicaid.
How many uninsured Floridians, including older Floridians, would benefit from Medicaid expansion? Over 1.5 million low-income Floridians would be eligible for Medicaid if/when Florida joins the 38 expansion states, including an estimated 400,000 Floridians aged 50 to 64.
Why are there so many older uninsured Floridians? The high number of uninsured is due to multiple factors, including: few employees in the state’s tourism and construction-based economy had health care benefits while they were working. Even those Florida jobs that do offer healthcare benefits virtually never provide pension-based healthcare for individuals who lose their jobs, often because of an illness or injury they cannot afford to treat. COBRA and marketplace insurance are too expensive for most older individuals. As a result, the older workforce tends to be less healthy and many must stop working before they reach age 65. These personal stories of older Floridians “barely hanging on” to age 65, when they qualify for Medicare, exemplify the situation.
How does not expanding Medicaid impact the health outcomes of older Floridians, and the costs to the healthcare system? By the time they reach age 65, uninsured older Floridians may have gone years without doctor visits, preventive care, and the early diagnosis and treatment of health problems. Thus, conditions that could have been treated early and at a lower cost, become serious and expensive. Take the example of a 65 year-old Floridian with Stage 4 colon cancer who has been without insurance for 10 years. By the time he enrolls in a Medicare plan, he needs surgery, radiation and chemotherapy. A life threatening illness and costly treatments could have been avoided with a routine colonoscopy and early treatment. Indeed, even before the pandemic greatly increased the number of uninsured, researchers documented that a significant number of older Floridians had already died due to the state’s decision not to expand Medicaid.
How does not expanding Medicaid impact the financial well-being of older uninsured Floridians? After losing their jobs, often due to treatable conditions, many older Floridians are forced to begin taking their Social Security retirement benefits early, in order to have some income. For example, Thomas, who would much rather work, had to get early retirement at age 62 to pay for housing and food. As a result, he and his wife will be spending their “golden retirement years” living barely above the poverty level on less than $1,200 per month.
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 A June 25, 2020 study by the Kaiser Family Foundation found that over 1.5 million Floridians, including those who experienced pandemic-related insurance loss, are eligible for Medicaid expansion. See, Rachel Garfield, et al., “How Many Uninsured Adults Could Be Reached If All States Expanded Medicaid?”. We derived our estimate of the number of older uninsured (400,000) from a Center on Budget and Policy Priorities (CBPP) study based on pre-pandemic data. The CBPP found that 184,000 of 693,000 (27%) Medicaid-eligible adults were aged 50-64. See, Jesse Cross-Call, et al., States that Have Expanded Medicaid are Better Positioned to Address COVID-19 and Recession. Using that proportion, we determined that approximately 400,000 of the 1.5 million currently eligible for Medicaid expansion are older Floridians.
 A study published by the National Bureau of Economic Research, see S.Miller et al., and summarized by CBPP found that between 2014 and 2017 found that 2,776 Floridians ages 55-64 died due to the state’s decision not to expand.