Description:

So geography depends on the state. Let's look right here. You can see that in the navy blue states, they have been implementing expansion for 2014. Three states are currently considering it. And the orange states have chosen at this time not to move forward for 2014.

If you look at Arkansas, you can see that they actually have a little star next to their name. That's because while they are expanding, they're not expanding through Medicaid. They're using a private option, which is actually what Indiana and Pennsylvania are considering doing as well.

So the original cutoffs in the ACA, the numbers that mattered, were 133, because below that you got Medicaid, and 400, because up to 400, you got assistance. But now it is different because Medicaid expansion is optional for the states. So in a state like Massachusetts or Colorado, choosing to expand, what you'll see is people have Medicaid up to-- just make my line a little thicker-- people have Medicaid up to 133% of the FPL. So they have Medicaid.

Once people are above 133% of the FPL, what you saw is they will go onto the exchanges, and they will get some assistance. And the type of assistance does vary, so we're just going to call it assistance. So these are exchange with assistance.

People who are above 400% of the FPL are not eligible for any federal assistance. So they can just go on the exchange. They shop in the same place. They don't have to go on the exchange. They can go on the exchange, and they can comparison shop. So it's no help. And this is the group above 400.

Now this is an expanding state. So what's happening here is basically the ACA original plan. The ACA was not written for Medicaid expansion to be optional, and we'll see the consequence of that in a few seconds. So now we're going to look at a non-expanding state. So think about Tennessee when you look at this.

In Tennessee, of the non-pregnant adults, especially without children, they're not going to get Medicaid. So there is no Medicaid expansion. What we're going to see is that many of them, between 100% and 400%, will go on the exchange with assistance. So the exchange with assistance.

At this point, you're probably thinking that what is going on here, because this 100 to 133 group, here they're getting Medicaid. Here they're getting the exchange with assistance. The way the ACA was written is Medicaid expansion was written up to 133, and exchanges were written to start at 100. So it's just kind of an overlap. And if you had the option for Medicaid, that is where you would end up. But in a non-expanding state, you have this little bit of an option here that you can actually go onto the exchange.

Now as far as being on the exchange without assistance, same group. Not getting any help. And they are above 400. So the real difference between these is-- look at this. In a state that doesn't expand, there is a big gap. And for people between 0 and 100% of the FPL, they are not having any insurance options that give them federal assistance. And as we saw, even in Tennessee, in the area of Tennessee I picked-- has some of the least expensive premiums in the country-- the cost of having insurance without any assistance may be completely not feasible.

Here is a link to the media file cryan_medicaid_w02_p03.mp4