Failure to Close Coverage Gap Would Leave Millions Uninsured and Facing Worse Health Outcomes
End Notes
[1] These states are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, and Wyoming. Wisconsin, the 12th non-expansion state, provides Medicaid coverage to adults up to the poverty line.
[2] Gideon Lukens, “Medicaid Coverage Gap Affects Even Larger Group Over Time than Estimates Indicate,” CBPP, September 3, 2021, https://www.cbpp.org/research/health/medicaid-coverage-gap-affects-even-larger-group-over-time-than-estimates-indicate.
[3] Letter to House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer, signed by Maya Wiley, President and CEO of the Leadership Conference on Civil and Human Rights, The NAACP, National Action Network, National Urban League, and UnidosUS, July 7, 2022, https://civilrightsdocs.info/pdf/healthcare/Coverage%20Gap%20letter_FINAL%207.7.22%20with%20signature.pdf.
[4] Laura Harker, “Closing the Coverage Gap a Critical Step for Advancing Health and Economic Justice,” CBPP, October 4, 2021, https://www.cbpp.org/research/health/closing-the-coverage-gap-a-critical-step-for-advancing-health-and-economic-justice.
[5] Gideon Lukens and Breanna Sharer, “Closing Medicaid Coverage Gap Would Help Diverse Group and Narrow Racial Disparities,” CBPP, June 14, 2021, https://www.cbpp.org/research/health/closing-medicaid-coverage-gap-would-help-diverse-group-and-narrow-racial.
[6] Kaiser Family Foundation, “Abortion in the United States,” July 2022, https://www.kff.org/womens-health-policy/press-release/abortion-in-the-united-states/. Of course, federal Medicaid funds can only be used to cover abortions in cases of rape, incest, or life endangerment of the pregnant person, meaning that access to abortion has already been very limited for many low-income people, even if they have health coverage.
[7] Lukens and Sharer, op. cit. This total does not include people in Wisconsin because although the state has not adopted the ACA Medicaid expansion, Medicaid coverage in Wisconsin is available to people up to the poverty line; individuals from 100-138 percent of the poverty line can access subsidized marketplace coverage.
[8] Julia D. Interrante et al., “State and Regional Differences in Access to Hospital-Based Obstetric Services for Rural Residents, 2018,” University of Minnesota Rural Health Research Center, August 2021, https://rhrc.umn.edu/wp-content/uploads/2021/09/UMN-State-Regional-Differences-in-OB_Policy-Brief_8.16.21_508.pdf.
[9] Black Maternal Health Federal Policy Collective, “The Intersection of Abortion Access and Black Maternal Health,” The Century Foundation, June 22, 2022, https://tcf.org/content/facts/the-intersection-of-abortion-access-and-black-maternal-health/; Judith Solomon, “Closing the Medicaid Coverage Gap Would Improve Black Maternal Health,” CBPP, July 26, 2021, https://www.cbpp.org/research/health/closing-the-coverage-gap-would-improve-black-maternal-health.
[10] While most non-expansion states have extended limited coverage of family planning services to adults who are otherwise ineligible for Medicaid, including those in the coverage gap, these programs are not a substitute for access to more comprehensive health coverage. Not only are benefits in these programs limited to family planning services, but awareness of the programs and access to providers is limited and states can provide less extensive contraceptive services than what’s available to people eligible under Medicaid expansion.
[11] For example, Alabama, Mississippi, and Tennessee have some of the highest rates for maternal death in the country. NCHS, “Maternal deaths and mortality rates: Each state, and the District of Columbia, United States, 2018-2020,” National Vital Statistics System, https://www.cdc.gov/nchs/maternal-mortality/MMR-2018-2020-State-Data.pdf. See also the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER) database, https://wonder.cdc.gov/.
[12] Solomon, op. cit.
[13] Marie E. Thoma and Eugene R. Declercq, “All-Cause Maternal Mortality in the US Before vs. During the COVID-19 Pandemic,” JAMA Network Open, June 28, 2022, 10.1001/jamanetworkopen.2022.19133.
[14] Solomon, op. cit.
[15] Maggie Clark, Ema Bargeron, and Allie Corcoran, “Medicaid Expansion Narrows Maternal Health Coverage Gaps, But Racial Disparities Persist,” Georgetown University Health Policy Institute Center for Children and Families, September 13, 2021, https://ccf.georgetown.edu/2021/09/13/medicaid-expansion-narrows-maternal-health-coverage-gaps-but-racial-disparities-persist/.
[16] Erica L. Eliason, “Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality,” Women’s Health Issues, February 25, 2020, https://www.whijournal.com/article/S1049-3867(20)30005-0/fulltext.
[17] Kaiser Family Foundation, “Medicaid Postpartum Coverage Extension Tracker,” July 8, 2022, https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker/.
[18] Gideon Lukens, “Health Premiums Will Rise Steeply for Millions if Rescue Plan Tax Credits Expire,” CBPP, May 26, 2022, https://www.cbpp.org/research/health/health-premiums-will-rise-steeply-for-millions-if-rescue-plan-tax-credits-expire.
[19] Manatt Health, “Assessing the Fiscal Impact of Medicaid Expansion Following the Enactment of the American Rescue Plan Act of 2021,” State Health and Value Strategies, April 2021, https://www.manatt.com/Manatt/media/Documents/Articles/ARP-Medicaid-Expansion.pdf.
[20] Judith Solomon, “Federal Action Needed to Close Medicaid ‘Coverage Gap,’ Extend Coverage to 2.2 Million People,” CBPP, May 6, 2021, https://www.cbpp.org/research/health/federal-action-needed-to-close-medicaid-coverage-gap-extend-coverage-to-22-million.
[21] Erin Brantley and Sara Rosenbaum, “Ballot Initiatives Have Brought Medicaid Eligibility to Many But Cannot Solve the Coverage Gap,” Health Affairs, June 23, 2021, https://www.healthaffairs.org/do/10.1377/forefront.20210617.992286/.
[22] Laura Harker, “Rounding Up the Top Five Reasons Congress Should Close the Coverage Gap,” CBPP, May 31, 2022, https://www.cbpp.org/blog/rounding-up-the-top-five-reasons-congress-should-close-the-coverage-gap.
[23] Jennifer Sullivan, Miriam Pearsall, and Anna Bailey, “To Improve Behavioral Health, Start by Closing the Medicaid Coverage Gap,” CBPP, October 4, 2021, https://www.cbpp.org/research/health/to-improve-behavioral-health-start-by-closing-the-medicaid-coverage-gap.
[24] Inna Rubin, Jesse Cross-Call, and Gideon Lukens, “Medicaid Expansion: Frequently Asked Questions,” CBPP, June 16, 2021, https://www.cbpp.org/research/health/medicaid-expansion-frequently-asked-questions.
[25] Matthew Fiedler, “How would filling the Medicaid ‘coverage gap’ affect hospital finances?” USC-Brookings Schaeffer Initiative for Health Policy, November 4, 2021, https://www.brookings.edu/essay/how-would-filling-the-medicaid-coverage-gap-affect-hospital-finances/; Harker, 2021, op. cit.