Nearly 12 Million People Are Uninsured but Eligible for ACA Financial Help

Although millions of Americans have gained coverage under the Affordable Care Act (ACA), and the uninsured rate has dropped to the lowest level ever recorded, many people remain uninsured. Some are still ineligible for coverage and others may be unaware of the availability of new coverage options or still find coverage unaffordable despite financial assistance.

A new analysis by the Kaiser Family Foundation (KFF) shows that as of the November 1, 2016, start of the fourth open-enrollment period of the ACA, 11.7 million people without health insurance are eligible for Medicaid in their state or are eligible for tax credits to purchase health insurance through their state’s ACA marketplace. There are an estimated 27 million Americans under age 65 who remain uninsured.

The analysis, “Estimates of Eligibility for ACA Coverage among the Uninsured in 2016,” was published October 18, 2016, by Rachel Garfield and colleagues at KFF, and provides detailed breakouts of data nationally and by state.

The analysis found that based on income and other factors, about 43% of the uninsured are eligible for financial assistance through the ACA either by enrolling in Medicaid (6.4 million) or through subsidies for purchasing coverage through the marketplace (5.3 million). The 15.5 million other people who remain without insurance are probably ineligible for Medicaid or tax credits because of income, immigration status, or availability of employer coverage, according to the KFF report.

Since the Supreme Court ruled that Medicaid expansion under the ACA is optional, 19 states have not implemented the expansion. As a result, some adults fall into a “coverage gap” in which they earn too much to qualify for Medicaid in their state, but not enough to qualify for premium tax credits.

Some 2.6 million poor adults, or 1 in 10 nonelderly uninsured people, fall into the coverage gap. The KFF analysis states that they are likely to remain uninsured as they earn too little to qualify for marketplace tax credits and lack any other affordable coverage options. Twenty percent of the uninsured (5.4 million) are undocumented immigrants, who are ineligible for Medicaid coverage and barred from purchasing coverage through the Marketplace.

There is wide variation among states in terms of the share and number of uninsured nonelderly residents eligible for financial help under the ACA, the analysis found. West Virginia, Louisiana, Vermont, and Montana are the states with the largest shares of the state population eligible for help; the states with the largest numbers eligible are California, Texas, Florida, and New York. (California and New York are Medicaid expansion states but Texas and Florida are not.)

Approximately one-fourth of the uninsured population is ineligible for assistance through the ACA because they have access to employer coverage or have incomes too high to qualify for Medicaid or Marketplace subsidies.

“As the beginning of open enrollment for 2017 Marketplace coverage approaches, there are still substantial opportunities to increase coverage by reaching those who are eligible for help under the ACA, particularly among children and the low-income population, who are eligible for the greatest assistance,” the KFF report concluded. “However, many of those who remain without coverage may be difficult to reach and could still remain uninsured.”