Uninsured Medicaid eligibles will vary in age and race
■ Of the 15 million who qualify for coverage in 2014, more than half may be white males, a new study says. Race and ethnicity differ by state.
A diverse group of uninsured adults will enter the Medicaid rolls in 2014, but many probably will be male, white and young, according to a new study.
About 15 million uninsured nonelderly adults are expected to gain Medicaid coverage under the Affordable Care Act’s expansion provision, helping their access to care while seeing their financial situations improve, according to an analysis issued Aug. 10 by the Robert Wood Johnson Foundation and the Urban Institute.
The study found that 55% of this population is white, 19% is black and 19% is Hispanic. The rest are in multiple or other ethnic or racial categories.
The fact that the majority of eligibles are white is due to the broadening of Medicaid’s eligibility criteria under the health system reform law and the fact that whites continue to represent a large share of the U.S. population, said Stephen Zuckerman, a senior fellow at the Urban Institute and a co-author of the analysis.
“It’s not that any one group — young men or whites — dominate,” he said. “It’s just that they’re a little more heavily represented among the newly uninsured than those who are currently uninsured.”
Current Medicaid eligibles are more likely to be single mothers and parents. But males are expected to make up 53% of the uninsured new eligibles.
With these additions in 2014, “you’re moving to a broader low-income population and, relative to that, you’re seeing a group that is more heavily represented by males,” Zuckerman said.
Race and ethnicity composition varies among the states. For example, Hispanics are more prominently featured in eligible populations in California, New Jersey, New Mexico, Florida and Texas. More blacks will be eligible in Georgia, Louisiana, South Carolina and Maryland.
Coverage increases through the ACA “could substantially reduce racial and ethnic differentials in health insurance coverage,” said the report (link).
About 7.8 million uninsured who are potentially eligible for Medicaid in 2014 are younger than 35. Thirty-five percent are between 35 and 54, and more than 10% are 55 to 64, the report said.
It’s not surprising that younger adults are more likely to be uninsured, Zuckerman said. “These are people in jobs [who] are just getting started, they’re in jobs that tend not to provide health insurance, and they have lower incomes.”
Forty-seven percent of the newly eligible uninsured are women. At least 4.6 million are women of reproductive age, and 2.7 million are parents with dependent children.
States are deciding whether to expand their Medicaid coverage up to 138% of poverty after the Supreme Court ruled on June 28 that they couldn’t be penalized for not participating in this expansion.
“Discussions about whether or not states plan to expand Medicaid under the [Affordable Care Act] have been dominated by budgetary concerns, particularly regarding potential state outlays and offsets associated with the Medicaid expansion” the report said.
A handful of Republican states such as Texas and Florida that oppose the health reform law already have announced that they won’t expand their programs.
Individuals between 100% and 138% of poverty in states that don’t expand their Medicaid programs could be eligible for tax credits to buy insurance through the state’s health insurance exchange. However, that eligibility doesn’t apply to those under 100% of poverty, meaning that some of the poorest residents in these states may not have access to any coverage.
The report said fiscal concerns that states have in expanding their programs “ignore the potential human, financial and productivity benefits” of providing affordable coverage to millions of uninsured, low-income adults.