Daily Briefing Blog

Which states will have the biggest coverage gaps next year?


Juliette Mullin, Editor

States' decisions to opt out of the Medicaid expansion will leave more than five million low-income Americans—or about 27% of uninsured residents—in an administrative "twilight zone" next year: They will not be eligible for the federal subsidies for insurance exchange plans or for Medicaid coverage.

A recent Kaiser Family Foundation (KFF) report breaks down that coverage gap by state—identifying more than a dozen states where more than 100,000 residents will have no new affordable coverage options.

Who falls in the gap

As it was originally written, the Affordable Care Act would expand coverage to millions of Americans in 2014 through its individual mandate and by making affordable coverage options available. Specifically, the federal government would offer insurance subsidies to residents making between 100% and 400% of the federal poverty level (FPL) and pay to expand Medicaid eligibility to include all residents making less than 138% FPL.

However, the Supreme Court in 2012 made Medicaid expansion optional, and many states have since rejected the federally funded eligibility increase.

  • Get primed on Medicaid expansion. Find out more about the ACA provision—and whether your state is opting in.

As a result, there are no new affordable coverage options for residents making below 100% FPL in states that opt not to expand Medicaid.

KFF: The states with the biggest gaps

For the KFF report, researchers analyzed U.S. Census Bureau data from 2012 and 2013 and states' Medicaid eligibility rules for 2014. They found that the five states with the biggest coverage gaps will be:

    1. Texas (1,046,430 residents)
    2. Florida (763,890)
    3. Georgia (409,350)
    4. Ohio (330,240)
    5. North Carolina (318,710)

According to KFF, nearly 50% of the uninsured individuals who are expected to fall into the coverage gap live in Florida, Georgia, and Texas. In addition, more than one-third of the uninsured residents in three other states—Alabama, Louisiana, and Mississippi—will fall into the gap.

  • Which states will have the most uninsured residents come 2016?
  • Using Harvard estimates and Advisory Board research, we've mapped out the expected uninsurance rates in each state after the 2014.
  • Check out this blog post explaining the method behind the map, and click here to expand the map.

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