« July 2014 Issue

Making Progress on Closing the Coverage Gap

Much has been said, written, blogged and tweeted about the millions who have gained coverage thanks to the Affordable Care Act during the first open enrollment period. While those gains in coverage (and the corresponding drop in the rate of uninsured nationwide) are to be celebrated, they would have been much greater if governors and legislators in 24 states had not refused to accept federal funding to provide health care coverage to additional low-income people in their states. Were it not for these policymakers actively denying health insurance to their constituents, nearly 5 million more people would be experiencing the peace of mind and economic security that health coverage brings.

To be clear, this is not a problem with the Affordable Care Act. The ACA provides a direct pathway to coverage for these low-income adults by increasing Medicaid eligibility for people who otherwise wouldn’t qualify and allocating funds to states to pay for this coverage. However, in June 2012, the U.S. Supreme Court ruled that governors could choose whether to accept or reject these federal dollars to increase coverage.

This means that in each state that has declined the federal funds, there is a “coverage gap” for adults who earn too much to qualify for the state’s existing Medicaid program but too little to get a tax credit through the Marketplace. In Texas, for example, as many as 1 million people fall into the coverage gap. But with the political climate around the Affordable Care Act as contentious as it is, many governors and legislators continue to put politics over people and refuse to close this coverage gap.

As consumer health advocates who support the implementation of the Affordable Care Act as it was fully intended, Community Catalyst works with state-based advocates to support their campaigns to close the coverage gap. “The ACA represents a huge step toward ensuring that quality, affordable health care is accessible to all who need it. Unfortunately, in states that haven’t closed the coverage gap, the ACA is a ladder with the bottom rungs missing,” says Katherine Howitt, our senior policy analyst who leads our work on Medicaid issues. 

Even as we work to ensure every state accepts federal funding for expanded Medicaid coverage, there is good news. Twenty-six states plus the District of Columbia have made the right decision to close the coverage gap, including some governors in quite conservative political environments and in every region of the country. Here are a few highlights from campaigns in those states:

With these and other successes, it is possible the tipping point is coming into view. The first open enrollment period transformed the coverage gap from a policy talking point to an on-the-ground reality for millions of people.

“During open enrollment, consumer health advocates and enrollment specialists saw the impact of the coverage gap firsthand, and it has taken their advocacy to a new level. The personal stories of people in the coverage gap are proving to be a powerful motivator for building a movement,” explains Howitt.

Unlikely partners are joining the cause and state advocates are keeping the drumbeat going in all corners of the country. It will likely be a long road ahead for advocates in the most conservative states, but we think it is a winnable fight. Moreover, campaigns to close the coverage gap will support and build a more formidable health justice movement that has the potential to open doors to other consumer-friendly improvements in our health care system.

Lucy Cox-Chapman, Communications Manager

O N   T H E   W I R E

Health Care Advocacy is on the Move! Longtime collaborators Community Catalyst, Health Care for All and Health Law Advocates are moving to new office space. After September 20, you can find us at One Federal Street in downtown Boston. We want to offer our thanks and appreciation to Attorney Diane McDermott who negotiated the lease for our new space pro bono. Diane is a partner at Holland & Knight's Boston office and a member of the firm's Real Estate Practice. Thanks to Diane for her work on our behalf. Stay tuned for more news about the move in upcoming editions.

Community Catalyst Executive Director Robert Restuccia and former President and CEO of UMass Memorial Health Care, Inc., John O’Brien, write in Health Affairs that the ACA provides hospitals and communities with an important opportunity to come together to build a more sustainable health system.

Our new report, “Connecting Consumers to Coverage: Mobilizing for Enrollment,” shares the story of the unique and important role state consumer health advocates played in helping 12 million consumers gain coverage during the first Affordable Care Act open enrollment period.

As coverage rates improve and the ACA is fully implemented, what’s next in health care? Read our new blog series, Better Bang for the Buck, that looks at the interrelated issues of health care costs and quality from a consumer point of view.

Community Catalyst Senior Policy Analyst, Christine Barber, explains in POLITICO how even people who are aware that financial assistance is part of the ACA don’t always realize that they may qualify and benefit from the law.

Boston led the way in June in offering coverage for transgender health care services and the state of Massachusetts quickly followed suit. Community Catalyst is proud to have worked with state and local advocates in promoting these policy changes to ensure that transgender city employees receive comprehensive benefits that cover all of their health needs. Read our blog post here.

Join us in welcoming our new staff members: Tera Bianchi, Ashley Blackburn, Amanda McIntosh, Gabrielle Novello, Nell O'Connell, Melissa Ough, Jessicah Pierre, Emily Polk, Amanda Ptashkin, and Rachelle Rubinow.

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