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Nearly Half of Uninsured Are Eligible for Subsidized Health Coverage

Outreach workers are focused on finding these people and getting them coverage.

Washington – Nearly half of the 32.3 million Americans without health insurance are eligible for Medicaid or federally-subsidized marketplace coverage, according to a new analysis by the Kaiser Family Foundation.

And of these 15.7 million uninsured Americans eligible for assistance, roughly 40 percent reside in just five states: California, Texas, Florida, New York and Pennsylvania.

With the 2016 marketplace enrollment period set to begin on November 1, the Obama administration and its legions of outreach and enrollment workers are focused on finding these uninsured people and getting them into coverage.

Enrollment efforts will target the remaining uninsured in cities like Dallas, Houston, Chicago and Miami, as well as in northern New Jersey.

The Affordable Care Act requires that most Americans get health insurance for 2016 or pay the higher fine of either 2.5 percent of annual household income or $695 per uninsured person. The penalty is $347.50 for uninsured children under age 18.

Of the nation’s 32 million-plus uninsured, about 7.1 million – or 22 percent – qualify for premium tax credits that help offset the cost of marketplace coverage. Meanwhile, 5.4 million, or 17 percent, are eligible for coverage through Medicaid, the state-federal health program for low-income Americans.

Another ten percent, or 3.2 million, qualify for coverage through the Children’s Health Insurance Program. An additional 3.1 million lack coverage because they fall into the “coverage gap” – meaning they don’t earn enough to get premium tax credits, but earn too much to qualify for Medicaid in states that didn’t expand income eligibility for the program.

By virtue of a US Supreme Court decision, the Affordable Care Act gives states the option of extending Medicaid coverage to working-age adults who earn at or below 138 percent of the federal poverty level – $27,724 for a family of three.

In the 30 states and the District of Columbia which expanded Medicaid eligibility, 40 percent of the non-elderly uninsured is eligible for the program, compared to just 13 percent in the 20 states that did not expand Medicaid, the Kaiser analysis found.

The rest of the nation’s 32.3 million uninsured are 4.9 million undocumented immigrants who are ineligible for the Affordable Care Act, another 4.9 million people who haven’t signed up for job-based coverage and 3.7 million who earn too much to qualify for premium tax credits and must purchase unsubsidized marketplace coverage.

Last month, Health and Human Services Secretary Sylvia Burwell estimated there were 10.5 million uninsured Americans still eligible for marketplace coverage.

Nearly half of them are young adults between ages 18 and 34.

About 40 percent of the remaining uninsured who qualify for marketplace plans are low- to moderate-income workers, earning about $30,000 to $60,000 for a family of four. About half have less than $100 in savings, which means they may have difficulty paying for coverage.

And nearly 60 percent don’t know about or how to access the tax credits that can help them pay for marketplace insurance.

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