Americans Left Behind by Health Reform

March 12, 2014

In order to expand access to health care to all Americans, the Affordable Care Act (ACA) attempted to expand Medicaid eligibility in all U.S. states.  The federal government is obligated to pay 100% of the cost of the Medicaid expansion for 3 years, and at least 90% of total costs thereafter (Medicaid is funded jointly by states and the federal government).

However, after the law passed, some states sued the government, arguing that the Medicaid expansion was an overreach of federal powers and would greatly raise their state’s Medicaid costs.  In June 2012 the Supreme Court ruled that each state could decide whether or not to expand their Medicaid program and access the additional federal funds.

So far only 25 states and Washington, DC have decided to expand Medicaid.  The Medicaid eligibility guidelines for children, parents and childless adults varies greatly from state to state.  As a result, a large number of consumers will find themselves in a “coverage gap” in states that do not expand Medicaid.

Approximately 5-8 million people in these states will fall into the coverage gap because their incomes are too high to qualify for their state’s Medicaid program, but are below the poverty level and therefore do not qualify for subsidies to buy insurance on the marketplaces.  Therefore, these people will likely remain uninsured and unable to access affordable health care.  (See reports from the Kaiser Family Foundation, Urban Institute, and the New York Times for more information).

Only four of the states that have chosen to not expand Medicaid cover parents up to 100% poverty level and therefore their residents won’t be caught in the “coverage gap.”  In some states eligibility is limited to those making less than 20% of the poverty level (less than $3,000 per year).  There remains little coverage for adults without children in the states not expanding Medicaid.

For people who are uninsured and have cancer or a history of cancer, having access to health insurance is critical.  CSC will be monitoring the impact of Medicaid expansion on people with cancer, and encourages you to visit Coverage Counts to learn more and find out what you can do to support efforts to expand Medicaid access.

If you have cancer, and are shopping for new insurance coverage, please share your story by emailing us at:

If you have cancer, a history of cancer, or are at risk for cancer and will be shopping for health insurance on your state’s marketplace, please use the Cancer Insurance Checklist, which will help you choose the best plan for you.

And as always, if you have concerns regarding your own cancer journey, you are encouraged to call CSC’s Cancer Support Helpline at 1-888-793-9355. We are ready to answer your call.