State Approaches to Expanding Health Insurance Coverage and Enrollment

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State Approaches to Expanding Health Insurance Coverage and Enrollment Exhibit 1 State Approaches to Expanding Health Insurance Coverage and Enrollment California New York Florida Texas Expanded Medicaid Yes No Qualifications for Medicaid Parentsa <138% FPL <33% FPL <18% FPL Childless adults Do not qualify for Medicaid Immigrantsb Legal immigrants qualify without the five-year waiting period Children of legal immigrants only qualify without the five-year waiting period Enrollment in Medicaid/CHIPc 11.9 million 6.4 million 4.3 million 4.8 million Marketplace type State-run Federal Federal Enrollment in the marketplaced 1,556,676 242,880 1,760,025 1,227,290 Note: FPL refers to federal poverty level. a Kaiser Family Foundation, Where Are States Today? Medicaid and CHIP Eligibility Levels for Children, Pregnant Women, and Adults, Fact sheet (Henry J. Kaiser Family Foundation, Jan. 19, 2017). b Medicaid.gov, Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women, Sept. 2016. For low-income immigrants lawfully residing in the United States, there is a five-year waiting period for enrollment in state Medicaid programs. Some states, including New York and California, have opted to eliminate these waiting periods. The ACA allows “qualified non-citizens” (such as those with a green card) who are in the five-year waiting period to enroll in marketplace plans and become eligible for subsidies, regardless of income. c Centers for Medicare and Medicaid Services, Table 1: Medicaid and CHIP: November and December 2016 Preliminary Monthly Enrollment (CMS, Feb. 2017). d Centers for Medicare and Medicaid Services, 2017 Marketplace Open Enrollment Period Public Use Files (CMS, n.d.). Total: CA vs FL; CA vs TX; NY vs FL; NY vs TX; TX vs FL

Exhibit 2 Uninsured Rate Drops by Varying Degrees in the Nation’s Four Largest States, 2012–2016 Percent of adults ages 19–64 who are uninsured Total: CA vs FL; CA vs TX; NY vs FL; NY vs TX; TX vs FL * The 2012 uninsured rate estimate for New York is from the National Health Interview Survey (NHIS). Data: The Commonwealth Fund Biennial Health Insurance Surveys (2012, 2014, 2016); and R. A. Cohen and M. E. Martinez, Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2012 (NHIS, June 2013).

Exhibit 3 Of the Four Largest States, Texas Has the Highest Uninsured Rate in Every Age Group Percent of adults ages 19–64 who are uninsured Data: The Commonwealth Fund Biennial Health Insurance Survey (2016).

State Uninsured Rates by Poverty and Firm Size Exhibit 4 State Uninsured Rates by Poverty and Firm Size Percent of adults ages 19–64 who are uninsured U.S. total California New York Florida Texas Unweighted n 4,186 716 739 663 699 Total 12% 10% 7% 16% 25% Poverty <100% FPL 22% 9% 15% 39% 100%–399% FPL 11% 6% 28% 400% FPL or more 3% 4% 2% 5% Firm size (Base: full-time or part-time workers) All workers 8% Small-firm workers (<50 employees) 21% 14% 24% 37% Larger-firm workers (50 employees or more) Total: CA vs FL; CA vs TX; NY vs FL; NY vs TX; TX vs FL Note: FPL refers to federal poverty level. Data: The Commonwealth Fund Biennial Health Insurance Survey (2016).

Exhibit 5 Adults in California and New York Reported Lower Rates of Cost-Related Access Problems Than Those in Florida and Texas Percent of adults ages 19–64 U.S. total California New York Florida Texas In the past 12 months because of cost: Had a medical problem, did not visit doctor or clinic 20% 15% 23% 27% Did not fill a prescription 19% 16% 17% Skipped recommended test, treatment, or follow-up 18% 14% 22% 25% Did not get needed specialist care 13% 11% 21% Any of the above access problems 34% 28% 29% 41% 45% Total: CA vs FL; CA vs TX; NY vs FL; NY vs TX; TX vs FL Data: The Commonwealth Fund Biennial Health Insurance Survey (2016).

Exhibit 6 Adults in California and New York Reported Lower Rates of Medical Bill Problems or Debt Than Those in Florida and Texas Percent of adults ages 19–64 U.S. total California New York Florida Texas In the past 12 months: Had problems paying or unable to pay medical bills 23% 17% 18% 28% 26% Contacted by a collection agency about medical bills* 21% 15% 25% Contacted by collection agency for unpaid medical bills 14% 9% 11% 16% Contacted by a collection agency because of billing mistake 5% 6% Had to change way of life to pay bills 12% 10% Any of three bill problems (does not include billing mistake) 29% 22% 32% 34% Medical bills/debt being paid off over time 24% 27% Any of three bill problems or medical debt 37% 41% 44% Total: CA vs FL; CA vs TX; NY vs FL; NY vs TX; TX vs FL * Subtotals may not sum to total: respondents who answered “don’t know” or refused are included in the distribution but not reported. Data: The Commonwealth Fund Biennial Health Insurance Survey (2016).