There is a common misconception that all low-income people–or, at least, all poor parents–are eligible for Medicaid. It may derive from a mistaken comparison with Medicare; an assumption that just as Medicare covers all people above a certain age, Medicaid must cover all people below a certain income level. In fact, only certain, limited categories of low-income people–children and pregnant women are two examples–are currently eligible for Medicaid, and the income threshold for each of these eligible populations varies by state.
While most states do not provide Medicaid coverage to childless adults at all–even those without any income–parents with dependent children are categorically eligible for Medicaid. In other words, states must cover some parents. However, because states are given great flexibility in setting the income eligibility threshold for parents, even very low-income parents often do not qualify for coverage. In Arkansas, a parent is only eligible for Medicaid if her income is below 17% of the federal poverty level (FPL)–$3,112 a year for a family of three. In Alabama, Idaho, Indiana, Louisiana, Missouri, and Texas, a parent of two making more than $5,310/year is ineligible for Medicaid. It’s no wonder that, as Martha Heberlein previously noted, 41% of parents with incomes below 150% FPL are uninsured.
It is important to note that when we talk about “parents” and Medicaid, we’re mostly talking about women. Over 20 million women are covered under Medicaid, comprising the majority (69%) of the program’s adult beneficiaries. Women are more likely than men to qualify for Medicaid because they tend to be poorer and are more likely to meet the program’s stringent eligibility criteria. Women are also more likely to hold low-wage or part-time jobs that do not offer employer-sponsored health benefits, so Medicaid may be their only possible source of coverage.
Health reform must provide coverage to the low-income mothers who are falling through the gaps.
New research conducted by the National Women’s Law Center begins to quantify health reform’s potential impact on low-income women with children–and the findings are dramatic. If Medicaid is expanded to all people with incomes at or below 133% of the federal poverty level (FPL), nearly 4.5 million uninsured women would be newly eligible for coverage–including over 1.6 million uninsured mothers.
Health reform would bring financial relief to moderate-income families as well. If premium subsidies are made available to people with incomes between 133% and 400% FPL, approximately 5 million uninsured women with children stand to benefit (including 4 million uninsured mothers and 1 million mothers currently purchasing health coverage in the individual health insurance market).
The list goes on. Health reform that sets essential benefit standards will help ensure that all women have access to the basic health care services that many plans currently exclude, such as maternity care. Currently, it is very difficult–and sometimes impossible–for women to find coverage for maternity care in the individual health insurance market. In fact, a National Women’s Law Center study found that the majority (59%) of individual health plans did not cover maternity care at all. Health reform recognizes that women don’t just need health insurance in name; they need meaningful coverage.
Health care reform also holds the promise of long-overdue insurance market reforms, many of which are critical for parents. Today, insurers in every state can exclude coverage for certain “pre-existing” conditions. If a woman has previously had a Cesarean section, for instance, insurers may refuse to pay for future C-sections or reject her application altogether. Given that nearly one in three births were by C-section in 2006, hundreds of thousands of women could face coverage exclusions or rejections because of this discriminatory practice. Health care reform will prohibit this unconscionable practice.
Reform that makes health care more accessible and affordable for women, important on its own merits, will also improve health care access for their children. Women make approximately 80% of health care decisions for their families. As Martha pointed out, children’s health and well-being can be significantly affected by their parents’ health and financial stability, and research has shown that providing coverage to parents promotes coverage and access to care for their children as well. Furthermore, it is self-evident why comprehensive maternity coverage (and a prohibition of pre-existing conditions exclusions) is important for children’s health.
Our health care system is failing women and their families. Fortunately, we’re closer to achieving significant reform than ever before. At this critical hour, it is all the more important that we advocate for health care reform that meets women’s needs–it is their health, and the health of their families, that hangs in the balance.
The views expressed by guest bloggers do not necessarily reflect the views of the Center for Children and Families.