Medicaid expansion slashed uninsured rates for poor, childless adults

Health insurance, pen and stethoscope
In states that didn't expand Medicaid, the uninsured rate for poor, childless adults was 47.8% in 2015, or nearly triple the rate seen in expansion states. Image: Getty/Minerva Studio

Though the Affordable Care Act’s Medicaid expansion brought about a slew of changes for the healthcare industry and consumers alike, new research indicated that poor, childless adults may have experienced the greatest impact.

In fact, the uninsured rate among poor, childless adults in Medicaid expansion states fell from 45.4% in 2013 to 16.5% in 2015, according to a study (PDF) by the Urban Institute with funding from the Robert Wood Johnson Foundation.

Coverage gains were even more pronounced among subgroups in this population, the study noted. For example, among adults ages 35 to 49, white adults and adults with at least some college education, relative coverage gains exceeded 50%. And childless adults in fair or poor health saw a “striking” 61.7% decline in their uninsured rate from 2013 to 2015.

“These strong coverage gains among people with health problems suggest that the ACA Medicaid expansion reached a group of vulnerable adults who likely had limited access to affordable coverage before the ACA,” the researchers noted.

States that chose not to expand their Medicaid programs, however, saw very different results. In these states, the uninsured rate for poor, childless adults was 47.8% in 2015, or nearly triple the rate seen in expansion states.

The study’s findings provide important evidence about the benefits of Medicaid expansion, the study added, in addition to highlighting the opportunities missed by states that haven’t expanded their programs.

In fact, some additional states are looking into expanding Medicaid in the wake of Republicans’ struggles to repeal the ACA. Others are considering applying for waivers that let them test conservative changes to the Medicaid program, such as work requirements for beneficiaries, which the Trump administration has encouraged.

Another recent report from the Urban Institute noted that hospitals located in states that expanded Medicaid saw a decline in their costs of uncompensated care, an increase in Medicaid revenue and improved profit margins.