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Coverage gap in state may leave 182,000 uninsured

October 17, 2013

A new report that 182,000 low-income residents could go without health insurance is refocusing attention on whether Indiana will win an exception to expand Medicaid using the Healthy Indiana Plan.

The Kaiser Family Foundation reported this week that 28 percent of the state's uninsured residents fall in that "gap" between Medicaid coverage and qualifying for subsidized insurance through the federal exchange. Nationally, the percentage is similar, but the number falling in that gap is more than 5 million.

"People in the coverage gap are likely to face barriers to needed health services or, if they do require medical care, potentially serious financial consequences. Further, the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be stretched in these states," according to the report.

Rachel Garfield, a senior researcher at Kaiser and one of the report's authors, noted that Indiana's percentage of uninsured residents who would be covered through a Medicaid expansion is similar to other states which have not expanded Medicaid. The states which did expand Medicaid, of course, do not have that coverage gap.

"These are adults without children, generally ineligible(for Medicaid) and they're the also the lowest income people for whom affording coverage on their own is very difficult," Garfield said. "Certainly for the Medicaid expansion component of the law, this was really who was targeted."

As open enrollment on the federal health exchange and state-run exchanges opened this month, many questions still remained about the status expanding Medicaid coverage for residents earning up to 138 percent of the federal poverty level. The U.S. Supreme Court upheld last year the mandate that residents own insurance, but struck down a provision forcing states to expand Medicaid.

Since then, many Republican-led states have resisted expanding Medicaid.

Gov. Mike Pence and Republican lawmakers, however, have supported expanding coverage using the Healthy Indiana Plan. The Pence administration won a one-year extension of Indiana's state-run alternative to Medicaid this past summer from the Center for Medicare and Medicaid Services. But negotiations with the federal government for an expansion of the plan were pushed back.

A spokeswoman for Pence was not immediately available for comment on the report Thursday.

If Indiana does not win its proposed expansion, the state will face the same problems the federal health care law was supposed to alleviate, said David Roos, executive director of Covering Kid and Families of Indiana.

"Those 182,000 are real live folks who need health care," he said.

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