Coverage Gap Leaves Millions of Americans without Affordable Health Insurance

According to a new report by the Kaiser Family Foundation, 2.2 million adults  are in a “coverage gap,” resulting from the failure of 17 states to expand Medicaid. As Say Ahhh! readers may recall, the coverage gap occurs among poor, non-elderly adults in non-expansion states who have incomes too high to be eligible for Medicaid but too low to qualify for the Marketplace’s premium tax credits.

Over half the individuals who fall into the coverage gap are concentrated in four states: Texas, Florida, Georgia, and North Carolina. Additionally, 55 percent of those in the coverage gap are between the ages of 35-64, which is when adults begin to have increasing health needs and thus have a greater demand for health coverage.

It’s worth noting that the average estimated cost of a premium on the marketplace for a 40-year-old, non-smoker in 2018 is $456 a  month for a silver plan without any subsidy. A premium at this cost counts for more than 70 percent of the income for those with the lowest income in the coverage gap.  

Also notable is the fact that although the majority of those affected by the coverage gap are  adults without children, 23 percent are parents, which has an impact on the coverage for children. Studies clearly demonstrate that when parents receive coverage through Medicaid, their children are also more likely to receive health coverage — also described as the “welcome mat” effect. The reverse is true, too: When parents do not have coverage, children have a greater risk for becoming – and remaining – uninsured.

If the parents currently in the coverage gap became eligible for Medicaid, there could be a positive impact on children’s uninsured rates as well.    

Allexa Gardner
Allexa Gardner is the Research Associate at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.