Curtain Rises on Health Insurance Marketplaces: Health Care for Millions of Uninsured is Just Three Months Away

Today is a landmark day for low-income individuals and families in the United States. Health insurance marketplaces opened, beginning the open enrollment period for health care coverage under the Affordable Care Act (ACA), including enrollment for Medicaid coverage in states that have expanded eligibility. Beginning today, depending on income, individuals will be able to purchase health care insurance with the help of credits and subsidies or enroll in Medicaid.  Come January 1, when actual health coverage begins, millions of low-income Americans will have access to affordable health coverage for the first time.

It may feel hard to celebrate, given today’s grim news of the federal government shutdown.  But we should pause today to recognize the importance of this moment:  the enormous potential of affordable health and mental health care coverage to help children, youth, families, and individuals who struggle with poverty, low wages, and unstable jobs.  Just a few examples:

  • In states that expand Medicaid to serve low-income adults with incomes up to 138 percent of the federal poverty level, many more parents (as well as other adults) will be eligible for health care coverage. This is very positive news not only for parents themselves but also for young children and for those who care about school readiness and educational success. Parents’ access to health care has lasting consequences for their children, because treating physical and mental health problems supports effective parenting.
  • The ACA also extends Medicaid to young people aging out of foster care until they turn 26, whether or not a state takes the Medicaid expansion option. This ensures these young people-just like others who can enroll in their parents’ plan-can have health insurance without interruption until they are 26 even though they are not living with their families. This provision is particularly important because of the high level of need for behavioral health treatment among this group of young people.
  • Today is also a day to celebrate access to affordable health care insurance for caregivers who work in human services organizations – child care teachers, youth workers, and others who work for low wages and, too often, insufficient benefits. Now, access to affordable health care insurance will help them take care of their own families while continuing to help others.

Most people without health insurance are low-income and many live in families with full-time workers.  Most low-wage workers currently lack access to employer-sponsored insurance and cannot afford premiums when offered. For low-income families, the lack of health insurance has immense implications. In addition to being less likely to access routine, preventive care and health services, low-income families without health insurance are at financial risk. High health care costs contribute to economic insecurity, sometimes forcing families to choose between paying medical bills or paying for other basic necessities. 

Prior to the opening of the health insurance marketplaces, states have been working at a frenzied pace to ensure that beginning January 1, eligible individuals will know about and get access to the coverage for which they qualify. A wide variety of organizations have been funded to help inform individuals about their options and guide them through the process.  The Centers for Medicare and Medicaid Services (CMS) has issued guidance to states on enrollment strategies that include streamlining enrollment in Medicaid for individuals currently receiving SNAP benefits and enrolling parents in Medicaid using existing data on children’s income eligibility.

States and the federal government will continue to work diligently in the coming months to implement ACA, but today there is reason to step back and recognize this momentous day that brings us one step closer to being a nation where health coverage is available regardless of income.