Fifty-Six Percent of the Uninsured Could Pay $100 or Less per Month for Coverage in 2014. Endnotes

09/01/2013

1 This number, based on the 2011 American Community Survey (ACS), is the estimate of Americans who are citizens or legal residents under the age of 65 and therefore eligible for coverage either in the Marketplace or through Medicaid. Some of these were eligible for Medicaid or CHIP coverage prior to 2014 but were not enrolled.

2 Totals do not sum due to rounding. See Table 2.

3 The Affordable Care Act requires that qualified health plans (QHPs) offered on the Marketplace must be one of four tiers, based on the QHP’s actuarial value.  A bronze plan has an actuarial value of 60 percent and will have the lowest premiums.  A silver plans has an actuarial value of 70 percent, a gold plan has an actuarial value of 80 percent, and a platinum plan has an actuarial value of 90 percent.   Two plans may have the same actuarial value but different premiums.  The tax credit available to certain qualified individuals under the Affordable Care Act is tied to the cost of the second lowest-cost silver plan available on the Marketplace in the tax filer’s state. 

4 We define Marketplace eligible as the eligible uninsured with incomes above 138% of the Federal Poverty Level in Medicaid expansion states or above 100% of the Federal Poverty Level in non-expansion states. These estimates do not take into account the eligibility requirements relating to other minimum essential coverage or tax filing requirements.

5 The estimates assume that the following 25 states will expand their Medicaid programs: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Dakota, Oregon, Rhode Island, Vermont, Washington, and West Virginia.

6 We estimate that if all states expanded Medicaid, 8.5 million uninsured could purchase silver or bronze coverage for $100 or less after the premium tax credit is applied, and 4.0 million uninsured children and 19.6 million uninsured adults would be available for CHIP or Medicaid at little or no cost for a total of 32.1 million.

7 As noted above, the tax credit amount is equal to the difference between the second lowest-cost silver premium and what the individual is expected to pay for health insurance based on income.

8 See http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPremiums/ib_premiums_update.cfm for a discussion of weighting methodology.

9 We do not include individuals and families with incomes below 100% of the FPL in non-expansion states in our definition of Marketplace eligible because we assume that they will receive hardship waivers exempting them from the coverage mandate.

 

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