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Census: States Not Expanding Medicaid Lagging on Health Coverage

States that have adopted the Affordable Care Act’s (ACA) Medicaid expansion had a much lower uninsured rate in 2017 than states that haven’t, and the gap continues to widen, new Census data show.

The ACA’s Medicaid expansion lets states provide coverage to all non-elderly adults with incomes up to 138 percent of the federal poverty line — including low-income adults without children. Some 6.6 percent of those in the 32 states (including the District of Columbia) that expanded Medicaid by January 2017 lacked health insurance that year, compared with 12.2 percent in the 19 non-expansion states (see chart), according to the Census Bureau’s American Community Survey.

The gap in uninsured rates between expansion states and non-expansion states has grown in four straight years, from 4.0 percentage points in 2013 to 5.6 percentage points in 2017 (see chart). If the uninsured rate had fallen in non-expansion states at the same rate since 2013 as it did in expansion states, another 4.5 million uninsured Americans would have had coverage last year.

Efforts continue in Maine to implement a Medicaid expansion to low-income adults approved through a ballot measure in November 2017. Voters in Idaho, Nebraska, and Utah will vote on similar ballot measures to expand Medicaid coverage this fall. Also, Virginia’s governor and state legislature enacted a bill to expand Medicaid coverage to low-income adults beginning in January 2019. Coverage gains in these states could be substantial based on the experiences of other states that have expanded Medicaid to low-income adults.

The federal government picked up all expansion costs through 2016 and will pay at least 90 percent of them in future years. Along with health coverage gains, expansion states have experienced improvements in residents’ health and financial well-being, and many have seen budget savings as the demand for state-funded health programs that serve the population dropped.