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Filling the Medicaid gap with a public option
Filling the Medicaid gap with a public option
- Collection:
- Health Policy and Services Research
- Series Title(s):
- U.S. health reform--monitoring and impact
- Author(s):
- Holahan, John, author
Simpson, Michael, author - Contributor(s):
- Robert Wood Johnson Foundation, issuing body.
Urban Institute, issuing body. - Publication:
- Washington, DC : Urban Institute, October 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Care Reform -- legislation & jurisprudence
Medicaid -- economics
Medically Uninsured -- statistics & numerical data
Poverty -- statistics & numerical data
Prescription Drugs -- economics
United States
United States. - Genre(s):
- Technical Report
- Abstract:
- As of July 2021, 12 states have not yet expanded Medicaid as permitted by the Affordable Care Act (ACA). These states, hereafter called “nonexpansion states,” have 14.6 million uninsured residents, including 5.8 million with incomes below the federal poverty level (FPL).1 Adults in these states with incomes below the FPL are generally ineligible for any financial assistance in obtaining health insurance. Policymakers are interested in filling this “Medicaid gap” by extending the ACA Marketplace subsidies to this group. Here we present three reform options for filling the Medicaid gap by expanding Marketplace subsidies to people with incomes below the FPL using different subsidy schedules. We explore how the effects of these reforms differ when they are based on Marketplace benchmarks versus when they are available through a public option. The public option would be a government-sponsored plan paying Medicare rates for hospital and other provider services and reduced (negotiated) prices for prescription drugs. Filling the Medicaid gap could significantly affect broader efforts to reduce uninsurance, because nonexpansion states have large numbers of uninsured people, their residents generally have lower incomes than people in expansion states, and several of them have large populations (e.g., Florida, Georgia, North Carolina, and Texas). The federal government would bear most of costs of filling the gap, but because benchmark premiums are high in many nonexpansion states, a public option could potentially provide the same coverage at a lower cost to the federal government. If Marketplace subsidies were used to fill the Medicaid gap, eligible people would be able to choose from among all Marketplace plans offered in a rating region. The federal government would pay for subsidies, specifically the difference between the percentage-of-income cap on consumers’ health insurance costs laid out in the subsidy schedule and the premium for each rating region's Marketplace benchmark plan. However, filling the Medicaid gap with a Marketplace expansion will still leave some people ineligible for assistance. People with an affordable offer of insurance from an employer cannot receive help with premiums under the ACA (although they could receive Medicaid if their state were to choose to expand). And people who are not legally present in the US are not eligible for any sort of federal assistance. On the other hand, many people with incomes below the FPL in nonexpansion states already have health insurance—either through an employer, purchased on the nongroup market without subsidies, or through the existing Medicaid program. Some of these people could benefit from extended subsidies, but others will not. To capture all people who could potentially be affected by reform, we present results of filling Medicaid gap for all people with incomes below the FPL in the 12 nonexpansion states.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (19 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918315984606676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918315984606676