States refusing Medicaid expansion leave 5.2M poor people without coverage, lose out on $555M

Two new studies highlight the heavy impact that state decisions not to expand Medicaid under the federal healthcare reform law will have on low-income Americans and community health centers that serve them.

Across the country, about 5.2 million low-income uninsured adults across the country will remain uninsured in 2014 because they fall into a coverage gap in the 25 states that so far have not expanded Medicaid to adults with incomes up to 138% of the federal poverty level, according to a new report from the Kaiser Family Foundation (PDF).

These people have incomes too high to qualify for Medicaid in those states but below the 100% of poverty level threshold to qualify for subsidized private coverage through their state insurance exchange.

More than a quarter (27%) of the uninsured population in states not expanding Medicaid falls into this coverage gap. More than half of the 5.2 million people in this gap live in Texas, Florida, Georgia, North Carolina, and Ohio—though Ohio officials seem close to approving Medicaid expansion. Texas alone has 1 million residents in this gap, while Florida has 764,000, and Georgia has 409,000.

The Kaiser study, which excluded undocumented residents because they are not eligible for publicly subsidized coverage under the healthcare law, was based on federal census data from 2012 and 2013 and state Medicaid eligibility rules for 2014.

Meanwhile, community health centers that disproportionately serve poor and uninsured people will lose out on $555 million in Medicaid payments next year because their states are not expanding Medicaid eligibility, according to a new study by George Washington University researchers (PDF). There are 518 centers in the 25 states that aren't expanding their programs.

At the same time, the 582 community health centers in states that are expanding Medicaid will receive about $2 billion in additional payments due to the expanded coverage, and see nearly 2.8 million of their patients gain insurance coverage.

Nationally, community health centers serve 7.4 million uninsured patients, the study said. If all the states chose to expand Medicaid, about 5 million of those uninsured patients would gain coverage. But with only half the states currently set to expand the program, about 4 million will gain insurance. Health centers in Alabama and Mississippi will face the highest rate of uninsured patients, at 43% and 42% respectively.

Because of their states' decision not to expand Medicaid, health centers in Texas will lose out on $83 million in 2014; Florida centers, $82 million; North Carolina centers, nearly $33 million; and Missouri centers, nearly $37 million.

The George Washington researchers said health centers in states not expanding Medicaid can be expected to fall further behind their expansion state counterparts in terms of service capacity, number of patients served, and in their ability to invest in initiatives that improve the quality and efficiency of healthcare.