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Providing needed access to healthcare for one in five people in the United States.

Despite massive reductions in the number of uninsured Americans as a result of states expanding their Medicaid programs under the Affordable Care Act, 10 states have not expanded eligibility, denying health coverage to nearly 2 million people. These people disproportionately come from communities of color and fall into what is known as the Medicaid “coverage gap.”

Although many people in the coverage gap are employed, they are less likely to have jobs that offer health insurance—this includes more than half a million essential workers. Many make too much money to be eligible for traditional Medicaid, but not enough to afford the cost of health insurance they purchase themselves. As an example, a single person in Texas who makes $10,000 a year doesn’t qualify for Medicaid, even though purchasing health insurance would cost more than half their salary.

Closing the Medicaid coverage gap is the single biggest action the country can take to reduce the number of uninsured. The refusal of some states to expand their Medicaid programs means that political considerations are being prioritized over healthcare, even in the midst of the ongoing COVID-19 pandemic where health insurance can be the difference between life and death.

The case for closing the Medicaid coverage gap:

  • Nearly 2 million adults across 10 states fall into the Medicaid coverage gap and are unable to access affordable, comprehensive health insurance because those states have refused to expand their Medicaid programs.
  • 60 percent of individuals in the coverage gap are people of color.
  • More than 550,000 essential workers fall into the Medicaid coverage gap.
  • Expanded Medicaid coverage has saved lives, reduced out-of-pocket costs, narrowed racial disparities, and provided peace of mind to those who would otherwise be living without insurance.
  • The average reduction in medical debt among people gaining coverage through Medicaid expansion is approximately $1,140.
  • Healthcare providers in states that expanded Medicaid saw a 45 percent drop in the cost of uncompensated care, which benefits their local economies.

Joint Statement Strongly Supports Congress Permanently Closing the Medicaid Coverage Gap

RWJF and public health and racial justice advocates state that, "in a country as wealthy as the United States, it is unconscionable that a person’s access to healthcare often comes down to skin color, gender, income, geography, disability, and employment or immigration status."

READ THE STATEMENT

Featured Content

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Blog Post

Closing the Medicaid Coverage Gap is a Health, Economic, and Moral Imperative

Closing the Medicaid coverage gap would save lives, reduce health care costs and help eliminate the racial and ethnic health disparities that have persisted for generations.

6-min read

RWJF Staff Perspective

Strengthening Medicaid should remain a national imperative

Advances made by states being permitted to expand their Medicaid programs under the ACA are now at risk, especially for families who lost coverage due to disenrollment when continuous coverage ended on April 1. “This is a moment to invest in Medicaid, not abandon it,” says Avenel Joseph, RWJF vice president for Policy. “Policymakers must meet the moment with the urgency it requires.”

Read the op-ed on Route Fifty
Medicaid Unwinding

Prioritizing Coverage Retention and Health Equity

Supporting States When the Medicaid Continuous Coverage Requirement Ends

A series from State Health and Value Strategies provides resources to support states in “unwinding” and prioritizing coverage retention.

Browse the series
Brief
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State Strategies to Compensate Beneficiary Advisory Council Members

This issue brief offers considerations for determining how to fairly compensate BAC members for their time without adversely affecting their eligibility for Medicaid.

2-min read

Healthcare Coverage and Access Policy and Law
Brief
A patient and doctor meeting in an office.

Changes in Health Care Cost Barriers with Medicaid Continuous Coverage and Enhanced Premium Tax Credits

An analysis of national survey data shows that policy changes implemented during the COVID-19 public health emergency made healthcare more affordable for nearly 5 million adults.

1-min read

Healthcare Coverage and Access
Research
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Advancing Solutions for Reproductive Justice

This series highlights some evidence-based policy solutions that can help advance reproductive justice.

1-min read

Health Disparities Policy and Law
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Financial barriers to care, particularly for people of color or those in low-wage jobs, is one of our nation’s clearest vulnerabilities. The Medicaid program is a critical lifeline for individuals in historically underserved communities and vital for improving the health of the nation.

Avenel Joseph, PhD, vice president, Policy

Medicaid Expansion is a Win for All

Expanded coverage has saved lives, reduced healthcare costs, narrowed racial disparities, and provided peace of mind to those who would otherwise have been uninsured.

Download the infographic

Research from the Field

That's Medicaid

Stories from every state of people covered by Medicaid at critical points in their lives.

State Network

Resources on state health policy for busy policymakers and researchers.

Medicaid Explained

A nonpartisan refresher of what congressional staffers need to know about Medicaid.

Closing the Medicaid Coverage Gap to Narrow Racial Disparities

2.2 million uninsured adults with incomes below the Federal Poverty Level are caught in the Medicaid “coverage gap.”

Health Equity and Medicaid Enrollment

Expanding access to Medicaid is one vital option for improving the health of historically underserved communities.

Status of State Medicaid Expansion Decisions: Interactive Map

Forty-one states have adopted the Medicaid expansion; 10 states have not.

Balancing Medicaid Budgets and Serving State Residents During A Pandemic

Key factors for state leaders to consider when balancing state budgets and making decisions about funding Medicaid during the COVID-19 crisis.

Monitoring Medicaid Using Lived Experience

A guide highlights learnings from over 50 nonprofit organizations with the goal of grounding Medicaid advocacy in lived experience.