What If Every State Expanded Medicaid?

The percentage of Americans who do not have health insurance has plummeted over the past few years, thanks to the Affordable Care Act. When the ACA was enacted in 2010, a substantial 18.2 percent of people under age 65 did not have health insurance. By 2017, just 10.7 percent did not have health insurance, according to the National Center for Health Statistics. The decline would be even greater if every state adopted Medicaid expansion, according to an analysis by Matthew Buettgens of the Urban Institute.

One of the provisions of the Affordable Care Act was to expand the Medicaid program in every state, providing insurance to people with incomes up to 138 percent of poverty level. As of March 2018, however, only 31 states and the District of Columbia had chosen to expand the program. If the 19 holdout states had a change of heart, according to Buettgens' analysis, the number of Americans without health insurance would fall by more than 4 million. Expanding Medicaid would reduce the number of nonelderly without health insurance by at least 20 percent in each of the 19 states and by an even larger 34 percent in Mississippi, 32 percent in Idaho, and 30 percent in Missouri. The percentage of the nonelderly without insurance in those states would drop from 16.9  to 12.6 percent on average, and it would fall into the single digits in six states including Maine and Wisconsin.

While Medicaid expansion would increase a state's Medicaid spending, the savings in other areas would more than make up for the cost, Buettgens says. "The research shows that, compared with nonexpansion states, Medicaid expansion states have seen larger declines in the number of uninsured people, lower uncompensated care, economic benefits from additional health care spending, and net gains to state budgets."

Source: Urban Institute, The Implications of Medicaid Expansion in the Remaining States: 2018 Update