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Thousands of Virginians fall into health insurance “coverage gap”

Nearly 191,000 Virginians fall into a “coverage gap” in which they don’t qualify for Medicaid and also don’t qualify for federal tax subsidies meant to help low-income people buy health insurance, according to a new report from the Kaiser Family Foundation.

The gap exists because states don’t have to expand Medicaid eligibility to cover more people, and Virginia is one of the states that has not expanded the program.

The federal Affordable Care Act created both the eligibility expansion and the tax subsidies, which are available to people whose incomes are between 100 and 400 percent of the federal poverty level if they buy insurance through the federal health insurance marketplace. That marketplace launched, with a number of software problems, on Oct. 1.

The ACA’s intention was to cover the poorest people through state expansion of Medicaid eligibility. Under the law, the federal government is supposed to pay 100 percent of the cost of that expansion for the first three years, and 90 percent thereafter. The law didn’t provide for subsidies for those people with the lowest incomes because it was intended that they’d be covered by Medicaid.

But the Supreme Court ruling that upheld the ACA as constitutional also said that state Medicaid expansion was optional.

As of September, 24 states and the District of Columbia have expanded Medicaid, according to the Kaiser Family Foundation. Virginia is among the 26 states to so far opt not to expand the program to cover people whose incomes are up to 138 percent of the poverty level. According to KFF, that’s about $27,000 for a family of three

Thus the coverage gap.

According to the KFF report that came out Wednesday, the 190,840 Virginians who fall into the gap represent 25 percent of all the uninsured, non-elderly people in Virginia, and 89 percent of the poor—people with incomes less than 100 percent of poverty level—non-elderly uninsured.

Nationally, more than 5 million people fall into that coverage gap in states that are not expanding Medicaid, according to the report.

In Virginia, as in many states, adults with no dependent children and who are not disabled are not eligible for Medicaid.

A legislative panel, the Medicaid Innovation and Reform Commission, is reviewing the state’s efforts to get federal permission for various reforms to the Medicaid program and will decide whether, based on those reforms, Virginia should move forward with expanding Medicaid eligibility.

Those who oppose the expansion say Virginia should not expand a program that already has problems and inefficiencies, and that the Medicaid system needs major reforms before an expansion should be contemplated.

They also doubt the federal government’s promise to pay most of the expansion’s cost, and say that even if those promises held up, the state would still be on the hook for more money than it pays now for Medicaid. Some also simply do not want to expand an entitlement program.

Those who favor the expansion say it will help low-income people access health care, will let Virginia recoup federal tax dollars, will create jobs and could lower overall health costs by reducing the number of uninsured who get costly care in emergency rooms.

A poll released Wednesday by Christopher Newport University’s Wason Center shows that those polled favor, narrowly, the Medicaid expansion.

The poll said 51 percent of those polled favored expansion. Most Democrats polled (86 percent) favored it, while most Republicans in the poll (76 percent) opposed it. Independents leaned toward opposition, with 51 percent saying they’re against the expansion.

The poll surveyed 944 registered voters, including 753 likely voters, with a margin of error for that smaller likely voter poll at plus or minus 3.6 percent.

The MIRC held a public hearing on the issue Tuesday in Richmond and will hold its next regular meeting Monday.

Also on Wednesday, the attorney general’s office warned people to be wary of scams related to the ACA and the process of signing up for health insurance through the federal insurance exchange.

In a press release, Attorney General Ken Cuccinelli said fake websites and scam phone calls already are popping up.

“Many citizens are mandated to buy insurance from this federal government-run exchange, and because they have to enter such detailed personal information online, scammers are finding this a target-rich environment to confuse people and steal their information in the process,” said Cuccinelli, who is running for governor and opposes the ACA.

He said consumers should be wary of “official-looking emails” that direct them to websites that aren’t the real federal exchange site (

He said people should give out personal information only if they initiate the phone call or website search.

“No one from the government will call, email or text you to sell you an insurance plan or ask for personal information,” Cuccinelli’s release said.

He also warned against high-pressure sales tactics—the government won’t threaten legal action—and suggested consumers ask for credentials from people offering to help them sign up. Only licensed insurance agents, certified application counselors and navigators are supposed to help consumers sign up.

Chelyen Davis: 540/368-5028