Exploring Characteristics and Health Care Utilization Trends among Individuals who fall in the Health Insurance Assistance Gap in a Medicaid Non-expansion State

摘要

States that did not expand Medicaid under the Affordable Care Act (ACA) in the U.S. have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥ 44% of the federal poverty level) but below the lower limit (< 100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this paper is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap (n= 166) in Missouri, a Medicaid non-expansion state, by comparing them to those who did not fall in the assistance gap (n=157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy and health insurance literacy. A select group completed a one-year follow-up survey about health insurance enrollment and health care utilization. Compared to the non-assistance gap group, individuals in the assistance gap were more likely to: have lower levels of education; have at least one chronic condition; be uninsured at baseline; and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared to the non-assistance gap group and were less likely to be insured through the marketplace or other private insurance at one-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs and improving access to care for underserved populations.