The Medicaid coverage gap and maternal and reproductive health equity

As Congress considers proposals to be included in the upcoming budget reconciliation package, a number of health care measures are on the table. Among these potential reforms are pathways to close the gap in Medicaid coverage that exists in the twelve states that declined to expand Medicaid after the passage of the Affordable Care Act (ACA). A Supreme Court ruling in 2012 made Medicaid expansion voluntary on a state-by-state basis, dealing a blow to the ACA’s approach to achieving universal health care coverage. As a result, in non-expansion states, 2.2 million people fall into a gap in coverage, wherein their income is too low to qualify for subsidies on the ACA Marketplace, but too high to qualify for Medicaid.
By its nature, the coverage gap impacts a vulnerable population: adults below 138 percent of the federal poverty level (FPL), without health insurance. The majority of these individuals are people of color, most are in the labor force, and about a third are parents. The geographic breakdown of Medicaid expansion—driven by partisan political decisions on the part of state legislatures and governors—means that most people in the coverage gap reside in the South and Midwest. Closing the coverage gap is a crucial step in lessening the inequities that it currently exacerbates, and has implications for women and birthing people in particular. Of the roughly 800,000 women of reproductive age in the Medicaid coverage gap, two-thirds are women of color. Unsurprisingly, women in the coverage gap also experience a health care gap, and face worse outcomes than insured women. This commentary will discuss the implications of the Medicaid coverage gap as it relates to maternal and reproductive health, and how Congress can—and must—end the coverage gap once and for all. (author abstract) #P4HEwebinarOctober2024