The ACA's language didn't account for the possibility that some states might not expand Medicaid, which is why the lower-end range of exchange plan subsidy eligibility starts off at 100% FPL...
Unfortunately, those earning less than 100% FPL are still stuck without any viable options besides either "going bare" and praying they don't get sick or injured or possibly buying a junk plan of some sort. According to the Kaiser Family Foundation, there's around 2.2 million Americans still caught in the "Medicaid Gap", where they don't qualify for Medicaid but don't earn enough to be eligible for subsidized ACA exchange policies (Kaiser estimates another 1.8 million uninsured adults in these states in the 100 - 138% "overlap" cateogory, plus around 356,000 who are eligible for Medicaid but still haven't enrolled for one reason or another).
Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Wednesday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.
The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million of state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.
The expanded eligibility would allow estimated 230,000 additional low-income Missourians to be covered. It is set to go into effect in July after voters approved a ballot question last August with a 53% majority.
Missouri just voted #YesOn2 to expand Medicaid, and now, because of YOUR vote, over 230,000 hardworking people will have access to life-saving healthcare!pic.twitter.com/azHN0GJjEW
— YesOn2: Healthcare for Missouri (@YesOn2MO) August 5, 2020
Last summer, when activists in both Missouri and Oklahoma were preparing for this historic vote, I wrote the following:
Last week the Maryland Health Benefit Exchange issued a press release touting impressive enrollment numbers over the past year via their year-long COVID-19 Special Enrollment Period (SEP). The topline number was that they enrolled over 140,000 Maryland residents in either ACA exchange policies or Medicaid.
Since Medicaid enrollment is open year-round anyway, the number I'm obviously more interested in are the exchange plans, which most people can normally only enroll in during the official Open Enrollment Period each fall/winter. Since COVID has thrown that mostly into disarray, however, I've been keeping a close eye on SEP enrollment in 2020 and now in spring of 2021 as compared to the pre-COVID era, when the SEP rules were far more strictly adhered to.
The American Rescue Plan does plenty to make private ACA-compliant health insurance dramatically more affordable for everyone earning more than 100% of the Federal Poverty Level. For those below 100% FPL, however, it takes an indirect approach. As I wrote a few weeks ago:
One possible "solution" would have been to simply remove the lower-bound income cut-off point for ACA exchange subsidy eligibility (that is, to lower the threshold from 100% FPL to 0%)...However, this would create two new problems: First, Medicaid is far more comprehensive than nearly all ACA plans...Secondly, if the lower-end subsidy cut-off were removed, it's almost certain that quite a few states which have already expanded the program would reverse themselves and allow Medicaid expansion to expire, in order to save the 10% portion of the cost that they have to pay.
The Maryland Health Benefit Exchange has issued a new press release which on the surface doesn't seem terribly unusual--it touts an impressive number of Maryland residents having gained healthcare coverage since they first launched their COVID-19 Special Enrollment Period (SEP).
What's unusual about this PR is that it's listing the cumulative number of people who've gained coverage since they launched their first COVID SEP a year ago:
MORE THAN 140,000 COVERED SINCE MARYLAND HEALTH CONNECTION LAUNCHED COVID-19 SPECIAL ENROLLMENT ONE YEAR AGO
236,000 WHO STILL LACK COVERAGE COULD GET IT FOR FREE OR WITH SIGNIFICANT FINANCIAL HELP
(MARCH 17, 2021) BALTIMORE — Yesterday marked one year since the Maryland Health Benefit Exchange launched a Coronavirus Emergency Special Enrollment Period in response to the public health emergency declared by Gov. Larry Hogan.
I'm a couple of weeks behind on this (the full #AmRescuePlan, #HR1319, already passed the House late last Friday night), but Medicaid expansion is one of the core issues I cover here, so it didn't feel right not to give this a write-up.
Before the Affordable Care Act was passed, only certain populations were eligible for Medicaid. Low-income children, pregnant women, parents of minor children and those with certain disabilities and so forth were eligible up to a certain household income threshold ranging from as a ceiling of as little as 13% of the Federal Poverty Line (parents in Alabama) to as much as 375% FPL (pregnant women and newborn infants in, interestingly, Iowa).
In other words, only about 10% (at most) of those still in the Medicaid Gap could remotely match the GOP's cliche of a "lazy, good-for-nothing layabout" type who's able-bodied, has no serious extenuating circumstances and so forth. The "get off your ass and work!" requirements appear to be nearly as big a waste of time and resources as the infamous "drug testing for welfare recipients" bandwagon which a bunch of states jumped on board over the past few years.
Back in November I noted that enrollment in Medicaid via ACA expansion has increased dramatically here in Michigan since the COVID-19 pandemic struck, increasing by 23% from 673,000 in February 2020 to 829,000 in November.
Today the Michigan Dept. of Insurance & Financial Services just issued the following press release:
More than 1 Million Michiganders Obtained 2021 Health Coverage from the Health Insurance Marketplace and the Healthy Michigan Plan
(LANSING, MICH) After an extensive joint outreach campaign by the Michigan Department of Insurance and Financial Services (DIFS) and the Michigan Department of Health and Human Services (MDHHS), more than 1 million Michiganders obtained health coverage for 2021 during the Health Insurance Marketplace open enrollment period or through the state’s expanded Medicaid program.
Back on December 19th, my colleagues Colin Baillio and Andrew Sprung picked up on something I had posted in response to the semi-final 2021 Open Enrollment snapshot report:
STATE LEVEL:
--25 out of 36 states outperformed last year
--Best % increase y/y: TEXAS (+14.9%)
--Worst $ decrease y/y: KENTUCKY (-6.7%)
I have no idea if there's anything special in either state which caused either to do as well/poorly as they did relative to last year.
From the state totals one obvious pattern leaps out: enrollment is up 9.7% in states that have not enacted the ACA Medicaid expansion -- and down 0.5% in states that have expanded the expansion (including Nebraska, which opened the Medicaid expansion doors in October of this year).
