Lawmakers and advocates regularly refer to Mississippians without health insurance who are stuck in the “coverage gap.” But what is the coverage gap, why does it exist, and how does it relate to Medicaid expansion?
What is Medicaid?
Medicaid is a federal-state program that provides health insurance to millions of people in the United States, including low-income adults, children, pregnant women, the elderly, and the disabled. The program is state-administered and funded by both the state and federal government. Mississippi participates in the traditional Medicaid program, but Congress is debating two different proposals to expand Medicaid.
What is a coverage gap?
The coverage gap refers to a specific group of uninsured people in states that have not expanded Medicaid under the Affordable Care Act, a federal health reform law enacted in 2010 under the Obama administration.
This law aims to make health insurance affordable and available to more people, and includes individuals with annual incomes ranging from 100% to 400% of the federal poverty level, or $18,210 to $72,840, respectively. It provides subsidies to lower costs for households with incomes of .
The Affordable Care Act also expanded Medicaid eligibility to adults under age 64 with incomes up to 138% of the federal poverty level, or $20,782 per year for individuals in 2024. 2012 US Supreme Court Decision Because the expansion was voluntary, it created a “coverage gap” for states that did not choose to expand the federal-interstate program.
Why does it exist?
In Mississippi and the other nine states that have not expanded Medicaid, incomes that are not low enough to qualify for non-expanded Medicaid, but below 100% of the federal poverty level, are low enough to qualify for Medicaid. There is a disparity between people making less than about $15,000 per year. Individuals can qualify for subsidized insurance through the federal marketplace. To qualify for Medicaid in Mississippi under current regulations, a household’s income must be less than 28 percent of the federal poverty level, or just under $7,000 a year for a family of three. Adults without children with disabilities are not eligible for Medicaid unless they meet other conditions.
How many people fall into the coverage gap?
Approximately 74,000 Mississippians are in the coverage gap; According to recent KFF research. Nationally, there are 1.5 million people.
How many people are uninsured in Mississippi?
According to the U.S. Census Bureau’s American Community Survey, Mississippi has one of the highest uninsured rates in the nation among working-age people in 2022, at 16.4%.
Are people in the coverage gap employed?
In 2019, of the 178,000 uninsured Mississippians, the majority were below 138% of the poverty level. almost 61% – were working or looking for work. Many people who are not in the labor force are unable to work because of mental health or medical conditions. Lack of transportation. Caregiving for a family member, recent incarceration, or other circumstances. More recent data has been skewed by the COVID-19 pandemic and the expansion of Medicaid coverage to people who otherwise would not have been eligible.
Nationally, the most common jobs for people in the coverage gap are cashiers, cooks, waiters/waitresses, construction/labor retail sales associates, and janitors, according to KFF.
According to the Hilltop Institute of the University of Maryland, Baltimore County, what prevents companies from offering health insurance to their employees or offering health insurance with a reasonable deductible?
Large employers with 50 or more employees are required to provide health insurance to their employees or pay a penalty. For small employers, health insurance is not mandatory. And because smaller employers are often more expensive, Benefits with higher deductibles and copays to reduce their expenses. As a result, people employed by small businesses may not have the option of purchasing health insurance or may choose not to purchase it due to cost.
Almost 69% of private businesses in Mississippi have fewer than 50 employees. According to the Agency for Healthcare Research and Quality. According to the Hilltop Institute at the University of Maryland in Baltimore County, that number rises to 95% when civil servants are included.
How many people will be eligible for Medicaid under the House and Senate plans, and how many of them will fall into the coverage gap?
The House plan is a traditional expansion under the Affordable Care Act that would make Mississippi eligible for hundreds of millions of federal dollars and is estimated to cover 200,000 Mississippians. This would include those in coverage gaps and others.
The Senate’s plan is not a traditional expansion and does not qualify the state to compete in the federal competition, but it would provide coverage to about 40,000 Mississippians. This would include only those in the coverage gap or up to 99 percent of the federal poverty level.
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