The Medicaid Gap Affects Real Idahoans

November 30, 2015 – Miranda Marquit –

As part of the passage of the Affordable Care Act (ACA – also called Obamacare), states were encouraged to expand Medicaid. In fact, Medicaid expansion was one of the main points of the law. In order to make the expansion easier on state budgets, the federal government even offered to pick up most of the tab to start.


While the U.S. Supreme Court has ruled that most of the ACA is legal, the mandatory state Medicaid expansion was struck down. As a result, some states decided to reject the expansion – and Idaho is one of those states. Without the expansion of Medicaid, there are many citizens falling into what has become known as the “Medicaid gap.”

What is the Medicaid Gap?

In order to qualify for a subsidy under the ACA, you have to make too much to qualify for Medicaid, but still be below an income threshold. However, the amount set as “too much to qualify for Medicaid” is based on the expansion calculations. In states where Medicaid expansion was put into place, more people qualify for Medicaid because the income requirements changed.

In states like Idaho, the income requirements for Medicaid haven’t changed. This means that people that the ACA was meant to cover through Medicaid expansion are in the position of making too much to qualify – but they don’t qualify for ACA subsidies (and can’t afford health insurance).

While many of these people can avoid the penalty associated with not being insured, it doesn’t change the fact that they are without access to health care. If Idaho would expand Medicaid like many other states have done (including conservative states like Arizona and New Mexico) and as some conservative governors, like Ohio’s John Kasich have encouraged, more of the disadvantaged and working poor could have access to health care services.

The Medicaid Gap is Deadly

Not only can the Medicaid gap make it difficult to pay for health care, but it can also be deadly. The reality of our for-profit health care complex is that sometimes people who need medications and treatments don’t get them. This was the case with Jenny Steinke, who died in September. The Post Register reported on her situation, which was tragic. She couldn’t afford insurance, but couldn’t use the health exchange to buy subsidized plans because she made too much for Medicaid, but not enough to be eligible for the ACA program.

Steinke had asthma, and had difficulty obtaining new inhalers and medication due to cost and lack of insurance. When she had a severe asthma attack and her inhaler didn’t work, she was rushed to the hospital, but died later due to related complications.

Steinke was one of the as many as 78,000 Idahoans in the Medicaid gap. It’s clear we have a substantial population that could benefit from Medicaid expansion in Idaho, and bi-partisan committees and community leaders have recommended expansion. And yet the legislature refuses to accept a simple solution that could improve citizen help and even save lives.

As the legislative session approaches, it’s a good time to contact your representatives and let them know that we want a healthier future for Idaho’s men, women, and children.



Miranda Marquit is a freelance financial journalist and money expert. She has a keen interest in politics and social justice and is excited to share news of interest to citizens in Bonneville County. Miranda enjoys reading, the outdoors and spending time with her son. She writes at Planting Money Seeds and Progressive Mormon Mom.

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