Medicaid expansion could cover more than 2M additional people

The uninsured population could drop by 25% in 10 states yet to expand Medicaid, an analysis from the left-leaning Urban Institute found with support from the Robert Wood Johnson Foundation.

Just 10 states—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming—have not yet expanded Medicaid eligibility, despite having the option under the Affordable Care Act.

If each state expanded Medicaid, more than 2.3 million people would gain access to health coverage, lowering the national uninsurance rate to less than 25%.

Mississippi and Alabama might have the most to gain from expanding Medicaid to non-elderly adults with incomes up to 138% of the federal poverty level. The analysis shows expansion could insure 39.4% and 37% of the states' uninsured populations. Most of the 10 states would see nearly a 20% reduction in uninsured rates, other than Wisconsin, which would reduce its uninsured rate by 8.1%.

“The coverage gap is perhaps the cruelest loophole in our fragmented coverage system. Expanding Medicaid eligibility in the remaining states would increase health equity, and generate health, social, economic, and fiscal benefits throughout the state,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, in a press release. “We know from studies of other states that expanding Medicaid improves health outcomes for those who gain coverage, disproportionately populations of color, and additionally supports healthcare providers, especially in rural areas, and creates jobs.”

Black adults would see the largest reduction in the uninsured rate (43.2% reduction). Black women of reproductive age would see a 51.3% reduction, while all women would drop by 31%. Of adults aged 19 to 24, the age group with the highest uninsured rate, the rate of uninsurance would decrease by 32.4%.

Choosing to expand Medicaid is a state’s choice, often opposed by state Republicans who reject increasing spending for the federal program. North Carolina is the latest state to formally expand Medicaid, with the launch occurring Dec. 1. It is expected more than 600,000 people will be added to the state’s health insurance system.

Georgia has implemented a Pathways to Coverage program, the only Medicaid program that mandates recipients meet a work requirement to obtain access. The program, while initially projected to provide insurance to 100,000 people, has so far only enrolled 1,343 people through the end of September, according to the Atlanta Journal-Constitution.

The Robert Wood Johnson Foundation report revealed that states that have already expanded Medicaid will save over the long term in healthcare expenditures and new revenue despite the short-term spending. State spending in the remaining 10 states would increase by $1.5 billion (partially offset by $457 million in government savings on uncompensated care), while federal spending on Medicaid in these states would increase by $24 billion (partially offset by $731 million).