Millions Eligible for Medicaid Go Without It

Millions Eligible for Medicaid Go Without It

Holdouts are a challenge to those looking to expand health coverage


Dejah Collier is a waitress, theme-park ride operator, mother of two, uninsured—and a sign of the continuing challenge in widening coverage under the federal health law.

Ms. Collier, a 24-year-old in the Denver area, had enrolled in the Medicaid federal-state insurance program to cover a hospital delivery for her second son but let her enrollment lapse later. Under the Affordable Care Act, her family’s income is low enough that they would all likely still qualify for the program, but they haven’t gone through the process to sign up again.

“It just became less important,” she said, adding that the family is healthy, and happy to pay cash for occasional services.

Among the 30 million people still without health insurance despite gains made under the 2010 health law, there is one surprising and poorly understood group: as many as six million people, like Ms. Collier, who are eligible to get near-free care through Medicaid but don’t sign up.

The Obama administration was closing out the latest sign-up period for coverage under the health law on Sunday, already heralding a late rush of applicants for private coverage. They put the administration well on track to exceed targets of having 10 million people enrolled in plans bought through and state equivalents at year-end, up from nine million at the end of 2015.

From here, making a bigger dent in the uninsured rate will likely hinge on Medicaid sign-ups, an area that has gotten little formal attention. Federal officials have focused on continuing to expand eligibility for Medicaid and will soon ask Congress for fresh financial incentives for the 20 states that hadn’t agreed to do so at the start of 2016.

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