The Patient Protection and Affordable Care Act is described as the most comprehensive overhaul of the U.S. health care system in the nearly 50 years since the enactment of Medicare and Medicaid to serve the elderly and poor, respectively. However as far reaching as it is, it fails to achieve its public policy goal of ensuring all Americans have access to an affordable health plan, concludes a Kaiser Family Foundation report.
The ACA and the Supreme Court’s June 2012 ruling in NFIB v. Sebelius invalidating the law’s mandate on states to expand Medicaid eligibility requirements means 5.2 million Americans residing in states that have not voluntarily opted to expand Medicaid eligibility – an estimated 27 percent of the medically uninsured – will remain without any form of public or private coverage.
The primary reason is in 22 of those 26 states, families earning less than 100 percent of the Federal Poverty Level (FPL) are under the ACA ineligible to purchase subsidized private coverage in the state health benefit exchange marketplace. But in most of those states, many families are also not eligible for Medicaid because their household income exceeds state Medicaid eligibility levels. (See Table 1 of the KFF issue brief, showing nearly all of those states cutting off Medicaid eligibility at 75 percent of FPL and most around half of FPL for a family of three). Also remaining uncovered in nearly all of those states (except Wisconsin) are low income childless adults earning less than 100 percent of FPL.
Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email