Who is Impacted by the Coverage Gap in States that Have Not Adopted the Medicaid Expansion? - January 2016

1. Who is Impacted by the Coverage Gap in States
that Have Not Adopted the Medicaid
Expansion?
Updated January 2016

2. Figure 1
Employer-
Sponsored,
55%
Medicaid/
Other
Public,
26%
Uninsured,
12%
Private
Non-
Group,
7%
NOTES: Medicaid and other public coverage includes: CHIP, other state programs, Medicare and military related coverage. Data may
not total 100% due to rounding.
SOURCE: Kaiser Family Foundation analysis of the 2015 ASEC Supplement to the CPS.
An estimated 32.3 million nonelderly individuals were uninsured
in 2014.
270.2 M Nonelderly

3. Figure 2
27%
27%
28%
400%+
FPL
15%
Family Income
(%FPL)
<100%
FPL
100-199%
FPL
200-399%
FPL
59%
26%
15%
Parent Status
NOTES: The U.S. Census Bureau's poverty threshold for a family with two adults and one child was $19,055 in 2014. Data may not
total 100% due to rounding.
SOURCE: Kaiser Family Foundation analysis of the 2015 ASEC Supplement to the CPS.
45%
14%
34%
5%
3%
Race
The majority of the uninsured are low-income adults, and
more than half are people of color.
Total = 32.3 Million Uninsured
Childless
Adults
Children
Parents
Hispanic
White
non-
Hispanic
Other
Asian/Native
Hawaiian or
Pacific
Islander
Black

4. Figure 3
Prior to the ACA, Medicaid eligibility was limited to specific low-
income groups.
Not
Eligible

5. Figure 4
Expanding Medicaid to low-income adults is a core component of
the ACA coverage expansions.
Medicaid Coverage For
Low-Income
Individuals
Employer-Sponsored Coverage
Marketplaces With Subsidies
For Moderate Income
Individuals
Individual
Mandate
Health Insurance
Market Reforms
Universal Coverage

6. Figure 5
NOTES: 138% FPL = $16,242 for an individual and $27,724 for a family of three in 2015.
As enacted, the ACA Medicaid expansion would cover adults up to
138% FPL in all states, filling long-standing gaps in coverage.

7. Figure 6
NOTES: Current status for each state is based on KCMU tracking and analysis of state executive activity. *AR, IA, IN, MI, MT, NH and PA have approved Section
1115 waivers. Coverage under the PA waiver went into effect 1/1/15, but it has transitioned coverage to a state plan amendment. Coverage under the MT
waiver went into effect 1/1/16. LA’s Governor signed an Executive Order to adopt the Medicaid expansion on 1/12/16, but coverage under the expansion is
not yet in effect. WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion.
SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts, updated January 12, 2016.
http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
But, the Supreme Court effectively made the Medicaid expansion a
state option.
WY
WI*
WV
WA
VA
VT
UT
TX
TN
SD
SC
RI
PA*
OR
OK
OH
ND
NC
NY
NM
NJ
NH*
NV
NE
MT*
MO
MS
MN
MI*
MA
MD
ME
LA*
KYKS
IA*
IN*IL
ID
HI
GA
FL
DC
DE
CT
CO
CA
AR*AZ
AK
AL
Adopted (32 States including DC)
Adoption under Discussion (3 States)
Not Adopting At This Time (16 States)
Status of Medicaid Expansion Decisions, January 12, 2016

8. Figure 7
297%
213%
138% 138%
214%
199%
44%
0%
Children Pregnant Women Parents Childless Adults
Adopted the Medicaid Expansion (32 states, including DC) Not Adopting at this Time (19 states)
Median Medicaid/CHIP Income Eligibility Thresholds, January 2016
NOTE: State-reported eligibility levels as of Jan. 1, 2016, updated to reflect Medicaid expansion adoption in Louisiana as of Jan. 12, 2016.
Eligibility levels include the standard five percentage point of the federal poverty level (FPL) disregard. As of 2015, the FPL was $20,090 for a
family of three and $11,770 for an individual.
SOURCE: Based on results from a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown
University Center for Children and Families, 2016 with data updates.
Medicaid eligibility for adults remains limited in states that
have not adopted the Medicaid expansion.

9. Figure 8
In states that have not adopted the Medicaid expansion, poor
adults fall into a coverage gap, earning too much to qualify for
Medicaid but too little for subsidies for Marketplace coverage.
asofOctober2014asofJanuary2016
44%FPL
$8,840forparents
inafamilyofthree
$11,770
foranindividual
$47,080
foranindividual

10. Figure 9
TX
26%
FL
20%
GA
11%
NC
8%
Other
States that
Have Not
Expanded
Medicaid
35%
Note: Totals may not sum to 100% due to rounding.
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of
January 2016 and 2015 Current Population Survey data.
South
89%
Midwest
7%
Northeast
1%
West
3%
An estimated 2.9 million nonelderly adults fall into the coverage
gap, most of whom reside in the South.
Total = 2.9 Million in the Coverage Gap
Distribution By Geographic Region:Distribution By State:

11. Figure 10
White
45%
Black
28%
Hispanic
23%
Other
4%
19-24
years
24%
25-34
years
24%
35-54
years
35%
55-64
years
17%
More than half of adults in the coverage gap are adults of color.
Adults in the coverage gap are of varying age and health status.
Total = 2.9 Million in the Coverage Gap
Distribution By
Age:
Distribution By
Race/Ethnicity:
Excellent
or Very
Good
50%Good
32%
Fair or
Poor
18%
Distribution By
Health Status:
Note: Totals may not sum to 100% due to rounding.
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of
January 2016 and 2015 Current Population Survey data.

12. Figure 11
No worker
38%
Part-time
worker
21%
Full-time
worker
41%
Notes: Industry classifications: Agriculture/Service includes agriculture, construction, leisure and hospitality services, wholesale and retail trade.
Education/Health includes education and health services. Professional/Public Admin includes finance, professional and business services,
information, and public administration. Manufacturing/Infrastructure includes mining, manufacturing, utilities, and transportation. Totals may not
sum to 100% due to rounding.
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of
January 2016 and 2015 Current Population Survey data.
48%
55%
6%
14%
46% 17%
8%
6%
Nearly two-thirds of adults in the coverage gap are in a family
with a worker, but most work in jobs that are unlikely to offer
insurance.
Family work status :
Total = 2.9 Million in the Coverage Gap
Firm size and industry among those working:
<50 employees
50-99
employees
100+
employees
Agriculture/
Service
Education/
Health
Professional/
Public Admin
Manufacturing
/Infrastructure
Other
Total = 1.5 Million Workers in the Coverage Gap

13. Figure 12
11% 10%
21%
7% 5%
11%
Total Whites Blacks Hispanics Other All People of
Color
Uninsured Black adults are more likely to fall into the coverage
gap than other racial/ethnic groups.
27.5 M 9.0 M3.9 M12.5 M 2.0 M 14.9 M
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of
January 2016 and 2015 Current Population Survey data.
Total
Uninsured
Adults
Share of Uninsured Adults Who Fall into the Coverage Gap, by Race/Ethnicity:

14. Figure 13
22%
27%
NOTES: Numbers may not sum to subtotals or 100% due to rounding. Tax-Credit Eligible share includes adults in MN and NY who are eligible for coverage
through the Basic Health Plan.
SOURCE: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of January 2016
and 2015 Current Population Survey data.
If all states adopted the Medicaid expansion, the coverage gap
would be eliminated and 59% of the nonelderly uninsured would be
eligible for financial assistance.
Total = 32.3 Million Nonelderly Uninsured
32%
17%
25%
Medicaid-Eligible
Adult
18%
Medicaid-Eligible
Adult
Tax-Credit EligibleTax-Credit Eligible
Unsubsidized
Marketplace/ESI Offer
Unsubsidized
Marketplace/ESI Offer
Medicaid-Eligible
Child, 10%Medicaid-Eligible Child,
10%
In the Coverage Gap, 9%
Ineligible due to
Immigration Status, 15%
Ineligible due to
Immigration Status, 15%
If All States Expanded MedicaidBased on Current Medicaid Expansion Decisions
Eligible for
Financial
Assistance
59%
Eligible for
Financial
Assistance
49%