Before and After ACA: State by State

The number of Americans without health insurance will drop sharply in all but one state after the Affordable Care Act goes into effect in 2014. The Urban Institute calculates the numbers, and its analysis shows that the decline in the number of uninsured will range from 25 percent in Vermont to more than 50 percent in eight states The only state in which the uninsured are not expected to decline is Massachusetts, where a version of the ACA has been available to state residents for years. Only 4 percent of Massachusetts residents do not have health insurance.

The decline in the number of uninsured would be much greater if every state had adopted the Medicaid eligibility expansion as was intended by the ACA. Mississippi, one of 26 states to reject the expansion, will see only a 29 percent reduction in its 544,000 uninsured versus what would have been a 54 percent reduction if the state had expanded Medicaid. In fact, 28 states rather than just 8 would see at least a 50 percent reduction in their uninsured if every state had adopted the Medicaid expansion.

Source: Urban Institute, Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation across States