« July 2014 Issue

Making Progress on Closing the Coverage Gap

Much has been said, written, blogged and tweeted about the millions who have gained coverage thanks to the Affordable Care Act during the first open enrollment period. While those gains in coverage (and the corresponding drop in the rate of uninsured nationwide) are to be celebrated, they would have been much greater if governors and legislators in 24 states had not refused to accept federal funding to provide health care coverage to additional low-income people in their states. Were it not for these policymakers actively denying health insurance to their constituents, nearly 5 million more people would be experiencing the peace of mind and economic security that health coverage brings.

To be clear, this is not a problem with the Affordable Care Act. The ACA provides a direct pathway to coverage for these low-income adults by increasing Medicaid eligibility for people who otherwise wouldn’t qualify and allocating funds to states to pay for this coverage. However, in June 2012, the U.S. Supreme Court ruled that governors could choose whether to accept or reject these federal dollars to increase coverage.

This means that in each state that has declined the federal funds, there is a “coverage gap” for adults who earn too much to qualify for the state’s existing Medicaid program but too little to get a tax credit through the Marketplace. In Texas, for example, as many as 1 million people fall into the coverage gap. But with the political climate around the Affordable Care Act as contentious as it is, many governors and legislators continue to put politics over people and refuse to close this coverage gap.

As consumer health advocates who support the implementation of the Affordable Care Act as it was fully intended, Community Catalyst works with state-based advocates to support their campaigns to close the coverage gap. “The ACA represents a huge step toward ensuring that quality, affordable health care is accessible to all who need it. Unfortunately, in states that haven’t closed the coverage gap, the ACA is a ladder with the bottom rungs missing,” says Katherine Howitt, our senior policy analyst who leads our work on Medicaid issues. 

Even as we work to ensure every state accepts federal funding for expanded Medicaid coverage, there is good news. Twenty-six states plus the District of Columbia have made the right decision to close the coverage gap, including some governors in quite conservative political environments and in every region of the country. Here are a few highlights from campaigns in those states:

• Ohio. The Buckeye state became the 25th state (plus DC) to expand Medicaid under the Affordable Care Act. This is a tremendous victory for the more than 275,000 low-income Ohioans who will now have affordable coverage – some for the very first time. It will also provide a much-needed boost for the state’s hospitals and overall economy, which will benefit from the billions of federal dollars flowing into Ohio to pay for this coverage. The Ohio Medicaid victory is a great example of an effective “system of advocacy,” in which advocates partner with a variety of stakeholder groups and weave together their varied capacities and strengths to achieve their goal. The Ohio advocacy community, in partnership with the Alliance coalition, executed all these strategies at key moments to build a strong case for Medicaid expansion. Their smarts, savvy and ingenuity – combined with the commitment from Governor Kasich – created the opportunity to close the coverage gap.
• New Hampshire. With consumer advocates leading a broad coalition of diverse stakeholders, New Hampshire passed a bipartisan bill to close the coverage gap in both the state House and the Republican-controlled state Senate. This initiative provides affordable coverage to an estimated 50,000 New Hampshire residents. We were particularly fortunate to be able to support New Hampshire advocates through Community Catalyst’s ACA Implementation Fund. In addition to philanthropic support, Community Catalyst worked in partnership with advocates to execute multiple strategies – policy analysis, messaging and communications, coalition building and grassroots support – all of which culminated in this step toward more expansive coverage.
• Pennsylvania. The debate over whether or not to close the coverage gap is ongoing in Pennsylvania. Although there is bipartisan support for closing the gap in the state House and Senate, Gov. Tom Corbett is advancing his own plan that would cut current benefits. Therefore, the Pennsylvania Health Access Network (PHAN) has rallied a statewide coalition to protect high quality health insurance coverage for individuals and businesses and to expand coverage to the uninsured. They are campaigning tirelessly to convince policymakers, the media, and the public of the widespread impact closing the coverage gap would have on the economy of the state and the lives of its residents. From their “Lives on the Line” campaign, to their message that the state can “close the budget gap by closing the coverage gap,” PHAN is making sure that policymakers know both the fiscal and personal effects of denying Pennsylvanians health care.

With these and other successes, it is possible the tipping point is coming into view. The first open enrollment period transformed the coverage gap from a policy talking point to an on-the-ground reality for millions of people.

“During open enrollment, consumer health advocates and enrollment specialists saw the impact of the coverage gap firsthand, and it has taken their advocacy to a new level. The personal stories of people in the coverage gap are proving to be a powerful motivator for building a movement,” explains Howitt.

Unlikely partners are joining the cause and state advocates are keeping the drumbeat going in all corners of the country. It will likely be a long road ahead for advocates in the most conservative states, but we think it is a winnable fight. Moreover, campaigns to close the coverage gap will support and build a more formidable health justice movement that has the potential to open doors to other consumer-friendly improvements in our health care system.

Lucy Cox-Chapman, Communications Manager