12 states refused to extend health coverage to the poor after passing the Affordable Care Act in 2010. But there is a way they can make people’s lives even better

Hispanic adults living in the 12 states that refused to extend health coverage to the poor after passage of the Affordable Care Act in 2010 would benefit the most from policy proposals to lower the age of Medicare eligibility to 60 , a new analysis shows.

Nearly 43% of Hispanic adults in non-Medicaid expansion states between the ages of 60 and 64 who also earn less than 138% of the federal poverty line — $18,754 for a family of one — are uninsured, according to University of Pittsburgh School researchers of Public Health found in an analysis published Thursday in the JAMA Network Open. That compares to the 18% of Hispanic adults of a similar age and income level who are still uninsured despite living in the 39 states did Expand Medicaid coverage.

“Our findings suggest a potential for lowering the Medicare threshold to age 60 to reduce existing coverage disparities among adults ages 60 to 64,” the researchers wrote, “particularly among low-income Hispanic adults in non- expansion states.”

Of low-income white adults ages 60-64 living in non-enlargement countries, 24.7% were uninsured. (According to the analysis, there was no significant difference in insurance levels between black and white adults of the same age and income group in expansion and non-expansion states.)

Typically, an older person can access Medicare health insurance by age 65 and join the tens of millions of other beneficiaries across the country who are currently receiving help paying for doctor visits, hospitalizations and prescriptions as they age. On the other hand, younger people with lower incomes who do not receive health care from their employer can access Medicaid or qualify for subsidies in the health care market, depending of course on where they live.

However, there are Americans who have virtually no affordable coverage options, and mostly it’s Blacks and Latinos living in states that haven’t yet expanded Medicaid. They may fall into the group of those who are too young for Medicare and poor for subsidies, but not poor and ill enough for their state’s restrictive Medicaid requirements – a problem often referred to as the “coverage gap.”

The Biden administration wanted to help fill that loophole in the failed Build Back Better Act by temporarily allowing people living below 100% of the federal poverty line to receive the market subsidies they have long been excluded from. Since Sen. Joe Manchin torpedoed that legislation by saying he could not support it last December, it’s unclear when — or if — that will ever happen.

As the Pittsburgh researchers pointed out in the JAMA analysis, lawmakers could also fill the gap with a “Medicare-for-more” policy that would lower the eligibility age, something President Joe Biden campaigned for and endorsed in his 2022 fiscal year budget proposal. Last year, US Rep. Pramila Jayapal, a progressive Democrat from Washington state, also led an effort by 130 House lawmakers to lower the eligibility age and expand coverage to at least 23 million people.

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