Medicaid, Marketplace Could Cover an Additional 15 Million People, Analysis Shows

How many uninsured people in the United States are eligible for coverage under the Affordable Care Act (ACA)? A new analysis from the Kaiser Family Foundation (KFF) found that 14.8 million people could gain coverage, either through Medicaid or by enrolling in a marketplace plan.

The ACA is still in effect, despite efforts to dismantle the program by the Trump administration, and KFF said that between now and open enrollment later this year, there are opportunities to increase health insurance coverage through promotional activities.

Since people with incomes below the federal poverty level (FPL) are not eligible for Marketplace subsidies, some adults in the 17 states that have not expanded Medicaid fall into a “coverage gap”—they make too much to qualify for traditional Medicaid, but not enough to qualify for premium tax credits.

In 2016, there were about 27.4 million uninsured people in the United States. Of those, 7 million are eligible for Medicaid or other public assistance, KFF said, and nearly 7.7 million eligible for tax credits. About 10.4 million are ineligible for health coverage, due to income, citizenship status, or other reasons.

In most cases, lawfully present immigrants are subject to a 5-year waiting period before they may enroll in Medicaid. They can purchase coverage through the marketplace and may receive tax credits. Undocumented immigrants are ineligible for Medicaid coverage and prohibited from purchasing marketplace coverage.

KFF said the administration has indicated to states that it is open to state Medicaid waiver proposals, which may lead some states that have not yet expanded Medicaid under the ACA to develop Medicaid expansion waivers and further extend coverage.

Under the ACA, Medicaid coverage has been extended to nearly all nonelderly adults with incomes at or below 138% of the FPL ($28,676 for a family of 3 in 2018) in the 34 states (including the District of Columbia) that had expanded as of this month.

Under rules in place before the ACA, all states extend public coverage to poor and low-income children, with a median income eligibility level of 255% of poverty in 2018. The ACA also established health insurance marketplaces where individuals can purchase insurance and allows for federal tax credits for such coverage for people with incomes from 100% to 400% FPL ($20,420 to $81,680 for a family of 3 in 2017).

Last year, the Trump administration cut the enrollment period for 2018 and slashed marketing. The administration also allowed association health plans, which are also expected to lead to a greater number of uninsured.