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Good question.

From Representative Kip Kendrick (D):

Kip Kendrick @Kip_Kendrick
Missourians represent at least a quarter million of these individuals.

Kaiser Family Foundation @KaiserFamFound
Nationally, 2.5 million poor uninsured adults fall into the “coverage gap” that results from state decisions not to expand Medicaid.
They earn too much to qualify for Medicaid, but not enough to…

3:09 PM – 30 Mar 2019

Rep. Kip Kendrick (D) [2019 file photo].

The human toll, from the Kaiser Family Foundation:

Table 1: Uninsured Adults in Non-Expansion States Who Would Be Eligible for Medicaid if Their States Expanded by Current Eligibility for Coverage, 2017

State Total Currently Eligible for Medicaid Currently in the Coverage Gap (<100% FPL) Currently May Be Eligible for Marketplace Coverage (100%-138% FPL**)

Missouri 232,000 13,000 124,000 95,000

[emphasis added]



The ACA Medicaid expansion was designed to address the high uninsured rates among low-income adults, providing a coverage option for people with limited access to employer coverage and limited income to purchase coverage on their own. In states that expanded Medicaid, millions of people gained coverage, and the uninsured rate dropped significantly as a result of the expansion. However, with many states opting not to implement the Medicaid expansion, millions of uninsured adults remain outside the reach of the ACA and continue to have limited options for affordable health coverage. From 2016 to 2017, non-expansion states saw a significant increase in their uninsured rate, while expansion states saw a decrease.

By definition, people in the coverage gap have limited family income and live below the poverty level. They are likely in families employed in very low wage jobs, employed part-time, or with a fragile or unpredictable connection to the workforce. Given limited offer rates of employer-based coverage for employees with these work characteristics, it is likely that they will continue to fall between the cracks in the employer-based system.

It is unlikely that people who fall into the coverage gap will be able to afford ACA coverage, as they are not eligible for premium subsidies: in 2019, the national average unsubsidized premium for a 40-year-old non-smoking individual purchasing coverage through the Marketplace was $478 per month for the lowest-cost silver plan and $340 per month for a bronze plan, which equates to nearly eighty percent of income for those at the lower income range of people in the gap and more than a third of income for those at the higher income range of people in the gap.

If they remain uninsured, adults in the coverage gap are likely to face barriers to needed health services or, if they do require medical care, potentially serious financial consequences. Many are in fair or poor health or are in the age range when health problems start to arise but lack of coverage may lead them to postpone needed care due to the cost. While the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be an important source of care for the remaining uninsured under the ACA, this system has been stretched in recent years due to increasing demand and limited resources.

Most people in the coverage gap live in the South, leading state decisions about Medicaid expansion to exacerbate geographic disparities in health coverage. In addition, because several states that have not expanded Medicaid have large populations of people of color, state decisions not to expand their programs disproportionately affect people of color, particularly Black Americans. As a result, state decisions about whether to expand Medicaid have implications for efforts to address disparities in health coverage, access, and outcomes among people of color.


From former State Representative Chris Kelly (D):

Chris Kelly @repckelly
And virtually all of them are working.
Props to @Kip_Kendrick for articulating this serious problem.
7:31 AM – 31 Mar 2019

But, the right wingnut republican majority in the Missouri General Assembly can’t believe this problem has adverse affects on rural Missourians? Right.