Stuck in the ‘Crater’

Q: How many low-income Oklahomans will remain in a health-care "coverage crater," ineligible for Medicaid and unable to buy subsidized coverage on the new online marketplace?

A: A new report released Wednesday by the Henry J. Kaiser Family Foundation estimates that  144,480 low-income non-elderly adults in Oklahoma will be stuck in a "coverage crater," ineligible for Medicaid and unable to buy subsidized  insurance on the new health-care marketplace.

That represents 90 percent of non-elderly adults in the state whose income is at or below 100 percent of the federal poverty level. Oklahoma's percentage, tied with Florida, is the second highest among the 26 states that are not moving to expand Medicaid under the Affordable Care Act, according to the foundation. The share for Texas, Idaho and North Carolina is 91 percent.

The coverage crater exists because Oklahoma Gov. Mary Fallin decided not to accept federal funds to expand the Medicaid program for the poor under the health-care law, saying it would be too costly. Under the law, in states without Medicaid expansion, most adults making at or below 100 percent of the poverty level -- $11,490 for an individual and $23,550 for a family of four --  earn too much to qualify for Medicaid but not enough to receive tax-credit subsidies to help pay premiums for private insurance on the new health-care marketplaces.

Oklahoma's federally run marketplace officially went online Oct. 1, but heavy traffic and technical problems have prevented many people from signing on to shop for coverage.

Previous estimates of Oklahoma adults under age 65 in the crater have ranged from about 130,000, cited by state health officials, to 170,000, provided by the Robert Wood Johnson Foundation. Oklahoma Watch reported earlier this year that a relatively high percentage of the state's adults in the crater are parents.

The Henry Kaiser Foundation found that Oklahoma's crater population represents 65 percent of uninsured, non-elderly adults whom "Obamacare" was originally intended to cover under expanded Medicaid. That is the highest share among states not expanding the program. The mandated full expansion was nullified when the U.S. Supreme Court ruled in 2012 that the federal government could not force states to expand the program.

The foundation estimated that 5.2 million non-elderly adults in the nation fall into the coverage crater.

"Most of these people have very limited coverage options and are likely to remain uninsured," the foundation's report said.

The Kaiser Foundation report:

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