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Connect With Us. Obamacare is a federal law, but it's also often used to refer to individual market health insurance obtained through the exchanges. Medicaid is government-run health coverage provided to people with limited incomes, and the expansion of Medicaid is a major cornerstone of Obamacare.
Since both terms involve health coverage, health care reform, and the United States federal government, they sometimes get conflated. Let's take a look at how Obamacare and Medicaid differ, including who provides the coverage, who's eligible, the enrollment periods, how costs are shared, and more. It was initially used in a pejorative sense by opponents of the law, but President Obama embraced the terminology in , and it's been used ever since by both opponents and supporters of the ACA.
Although Republican lawmakers and the Trump administration pushed for the repeal of numerous portions of the ACA throughout , the only part of the law repealed was the individual mandate penalty. The Tax Cuts and Jobs Act, enacted in December , eliminated the individual mandate penalty but not the individual mandate itself as of January While the term "Obamacare" technically encompasses all the ACA, people typically use it to refer to individual market health insurance plans sold in the health insurance exchanges.
That's how it'll be used for the rest of this article in a comparison of Obamacare and Medicaid. The most important difference between Medicaid and Obamacare is that Obamacare health plans are offered by private health insurance companies while Medicaid is a government program albeit often administered by private insurance companies that offer Medicaid managed care services.
They're offered by health insurance companies such as:. Obamacare health plans are not run by the government but must comply with various state and federal government regulations. It's worth noting, however, that more than two-thirds of Medicaid enrollees nationwide are on Medicaid managed care plans, so their insurance is administered by private insurers that also sell commercial insurance to individuals and businesses.
Those plans provide Medicaid benefits via a contract with state governments. This can be confusing to people, and it's compounded by the fact that in most states, the Medicaid program doesn't have "Medicaid" in its name Apple Health in Washington, for example, and BadgerCare Plus in Wisconsin. Legal immigrants: Note that in every state, legally present immigrants with income below the poverty level are eligible for premium subsidies if they're not eligible for Medicaid due to the five-year Medicaid waiting period for recent immigrants.
The criteria to get Medicaid are strict and vary from state to state. Coverage gap: As of early , there are 14 states that have not expanded Medicaid coverage to this group as noted above, this will drop to 12 states as of mid, when Missouri and Oklahoma implement Medicaid expansion. About 2. Wisconsin has managed to avoid a coverage gap despite not expanding Medicaid.
The state hasn't expanded Medicaid but provides Medicaid to residents with income up to the poverty level.
This Medicaid coverage is usually free to you, although some states charge a small monthly premium for coverage for people with income above the poverty level. They vary from state to state but include:. State without expanded Medicaid: Ineligible in coverage gap because you don't belong to a vulnerable group. Unfortunately, you'll be in the coverage gap and thus not eligible for Medicaid or a premium subsidy in the exchange because your income is under the poverty level.
If you're eligible for Medicaid , you can enroll throughout the year. However, enrollment in Obamacare plans is only available:. For example, if you enroll in an Obamacare plan during open enrollment in the autumn of , your Obamacare plan coverage will take effect on January 1, However, when you're accepted into the Medicaid program, there is no waiting period.
Coverage takes effect immediately. States that expand their Medicaid coverage will not incur unsustainable costs; rather they will enjoy net fiscal gains due to offsets in savings and increases in revenues. Sources of increased revenues include state sales taxes, insurance taxes, and prescription-drug rebates.
States will also incur savings, as the federal government will be paying a much higher share of the cost for populations that were previously ineligible and therefore solely paid for by states. Coverage for women with breast and cervical cancer, and coverage for some mental health and substance-abuse treatment for previously uninsured poor individuals can now be covered by Medicaid, as opposed to what was previously covered solely by states.
The reality is, however, that there is absolutely no precedent for this. Moreover, if a state is committed to expanding Medicaid, there are ways to address this concern.
There is both a human and fiscal cost if Medicaid expansion is rejected. And when it comes to the impact of Medicaid coverage, several studies indicate that Medicaid coverage leads to overall better health and lower mortality rates. According to a study by the state of Oregon, after one year of enrollment in Medicaid , low-income childless adults significantly reduced their financial strain, increased their health care use, and reported having overall better health.
Expanded Medicaid coverage also led to decreased rates of delayed care and decreased mortality rates , especially among residents of poorer counties, as indicated by the New England Journal of Medicine. When a state chooses to forgo expansion, it does not receive the extra funding from the federal government. This is a scenario that Gov. Jan Brewer R of Arizona, an outspoken foe of Obamacare, cites when explaining her surprising support for Medicaid expansion.
For the millions of low-income adults and children who would become eligible for care, Medicaid expansion is much more than access to health insurance. Medicaid coverage translates into financial flexibility for families and individuals, allowing limited dollars to be spent on basic needs, including breakfast for the majority of the month or a new pair of shoes for a job interview. Medicaid expansion means more than health care coverage; it is an expanded opportunity for success and a pathway to the middle class.
She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts. We do not sell insurance products, but this form will connect you with partners of healthinsurance.
You may submit your information through this form, or call to speak directly with licensed enrollers who will provide advice specific to your situation.
Read about your data and privacy. The mission of healthinsurance. Learn more about us. Expansion is optional, and some states continue to say no But in , the Supreme Court, while upholding the rest of the ACA, struck down the Medicaid expansion requirement, leaving it up to each state to decide whether or not to participate. But Georgia also planned to implement a Medicaid work requirement, which the Biden administration has said is a non-starter American Rescue Plan provides additional funding to entice holdout states to expand Medicaid The American Rescue Plan, enacted in March , provides two years of additional federal fundin g for states that newly expand Medicaid.
Medicaid eligibility varies depending on where you live In Washington, D. There are a few possible solutions, not all of which are adequate or realistic: For coverage You could move to a state that has expanded Medicaid, but that may be easier said than done for people with low-wage jobs, few assets, and few prospects elsewhere. Navigators have been invaluable in helping poor people tally up income from varied sources in order to get their total income up to the poverty level, where subsidies become available.
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