Significant shares of Obamacare customers still report difficulty in paying their medical bills, according to a study released Tuesday.
Twenty-three percent of enrollees in states without expanded Medicaid and 14 percent of enrollees in states with expanded Medicaid reported problems in paying their family medical bills, Urban Institute researchers found in a report published in the journal Health Affairs.
The Affordable Care Act has caused significant declines in the uninsured rate in all states, regardless of whether they expanded Medicaid. Many people have enrolled in marketplace plans, with Obamacare coverage increasing from 2.6 to 4.2 percent in expansion states and from 2.7 percent to 5 percent in nonexpansion states, between 2014 and 2015.
But the difference in affordability between expansion and non-expansion states underscores how Obamacare isn’t working the way it was intended, after the Supreme Court said states can opt out of Medicaid expansion.
The law expanded Medicaid for people up to 133 percent of the federal poverty level, and then provided subsidized private coverage for those earning more than that, up to 400 percent. But 19 states, all Republican-led, have chosen not to expand Medicaid, leaving some poor Americans in a “coverage gap” without affordable insurance options.
The researchers also found that for enrollees in states without Medicaid expansion, there was a higher unmet need for care than among enrollees in expansion states.
“The lack of a comprehensive Medicaid safety net leaves marketplace enrollees in nonexpansion states vulnerable to gaps in coverage should their incomes drop below the threshold of eligibility for marketplace subsidies,” the authors wrote.
Medicaid expansion has been a fraught issue in the Obamacare wars, as it provides states with a larger sum of federal money that is hard for them to turn down. A number of Republican governors, including vice presidential nominee Mike Pence, have accepted the Medicaid expansion but attached more rules to the program with permission from the Obama administration.
