NEW YORK (MainStreet) At age 33, Maya, who lives in Lakeland, Flor., had been working fulltime until she was laid off. Along with her job, she lost her health insurance and became financially strapped. Buying health insurance on her own was simply too expensive for her.
Maya, who declined to disclose her full name, is just one of the uninsured adults profiled by the Kaiser Family Foundation (KFF) Kaiser Commission on Medicaid and the Uninsured who could qualify for health insurance coverage under the new state Medicaid expansion created under the Affordable Care Act.
Medicaid, the government health insurance for low-income people, covers 60 million people, but that number will grow come January 2014. Currently, 29 states are moving toward expansion. according to The Advisory Board Company, a research and advisory firm. Medicaid expansion will provide coverage to the gap group, low-income Americans who make less than 138% of the federal poverty level and who are not eligible for subsidies to help pay for the health insurance sold through the new health insurance state marketplaces. Unfortunately for Maya, Florida is not among those states, at least not yet.
The focus group KFF reported on in November 2012 revealed that the gap group is diverse. Most of the group was employed, but remained financially challenged in meeting basic expenses. Many of the members faced financial burdens due to being uninsured and had unmet healthcare needs, which sometimes affected their ability to work. Not surprisingly, they reported that gaining access to healthcare through Medicaid expansion would provide relief to them and allow them to better manage their ongoing health conditions and reduce use of the emergency room.
A recently published study by University of Michigan researchers further defines this group. It shows that those who may qualify for Medicaid under the expansion, compared with the current beneficiaries, are more likely to be younger, white, male, smokers, and drinkers but possibly may be less likely to have depression or be obese. The researchers say this new group may be less expensive to cover than projected by the lawmakers.
"There has been a lot of debate about how expensive the Medicaid expansion would be and until now, it hadn't been clear which Americans had the potential to benefit from the added healthcare coverage in states that participate," says lead author Tammy Chang, an assistant professor in the department of family medicine at the University of Michigan Medical School.
Compared with the current Medicaid population, 49% of the gap group compared with 33% of the current beneficiaries will be male and 60% of the gap group versus 50% of the current beneficiaries will be white. Almost 50% of the people potentially eligible for the expansion are smokers, and more than one third of them are moderate or heavy drinkers.
The expansion also provides an opportunity to save taxpayers money by improving the health and preventing disease among this group, Chang says.
--Written for MainStreet by S.Z. Berg, author of College on the Cheap