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The Medicaid hole, revisited 

The Arkansas Times has written a number of times about the ugly situation that would occur if Medicaid expansion doesn't happen: People who make between 100 and 400 percent of the federal poverty level will be getting government subsidies to buy health insurance, but those who fall below 100 percent of FPL who don't qualify for Arkansas's stingy Medicaid program will be left out in the cold.

When asked about the people in this hole of coverage recently, Senate President Pro Tem Michael Lamoureux (R-Russellville) caused a little bit of confusion among followers of the healthcare law when he responded, "We've heard presentations that say that that group could be eligible for a full federal subsidy ... to buy health insurance for premiums as low as $29 a month."

The Times followed up with Lamoureux and it turns out that he actually intended to refer to people that make between 100 and 138 percent of FPL. And on this, he's right — people in that narrow category will be heavily subsidized on the healthcare exchange if Medicaid is not available to them. If Arkansas decides to expand Medicaid, anyone making up to 138 percent of FPL will be covered (including, of course, the group between 100 and 138). If Arkansas decides not to expand Medicaid, the 100-138 group won't get Medicaid, but they will be eligible for subsidies, which will lead to relatively affordable premiums. For example, with no expansion, an individual making 138 percent of FPL (a little more than $15,000 a year) would pay $26 per month out of pocket for a subsidized health-insurance plan bought on the exchange.

However, Lamoureux was under the impression that this was the core group under discussion, the oft-mentioned "250,000 people."

When a Times reporter explained that in fact the majority of uninsured folks who would gain eligibility with expansion fell below 100 percent of FPL — that the group of people that would be stuck in a "hole" without coverage or subsidies amounted to more than 160,000 folks if the state doesn't expand Medicaid, Lamoureux agreed that that would leave us with an ethically problematic result.

"If we're subsidizing people that are making more money and not people that are making less," he said, "I agree that's not a good situation."

He added, "I was not aware that that was that sizable of a number in that category."

The latest study from the Urban Institute projects that there are about 218,000 Arkansans who would be newly eligible for Medicaid if the state goes forward with expansion. Of those, 51,000 fall between 100 and 138 percent of FPL. If the state doesn't expand Medicaid, they will be eligible to buy heavily subsidized insurance on the exchange. The remaining 167,000 make less than 100 percent of the FPL. If Arkansas doesn't expand Medicaid, these people are out of luck, even as people making all the way up to 400 percent of FPL ($44,600 for an individual) get government help.

And what about that 250,000 figure? That's the state Department of Human Services projection of the total number of people that would be added to the Medicaid rolls with expansion. They project 215,000 newly eligible, just a tad under the Urban Institute's estimate. They also project that 35,000 people that are already eligible (25,000 adults plus 10,000 kids) for Medicaid but haven't signed up would end up enrolling because of the publicity about the Medicaid program associated with expansion.

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