Uninsured would drop by millions, enrollment would swell if Medicaid expansion holdouts opted in

Photo by David Herrera

Nineteen states have yet to expand their Medicaid programs under the Affordable Care Act, and a new study from the Robert Wood Johnson Foundation shows just how much enrollment would increase if they did: 7.8 to 8.8 million, while the number of uninsured would decline between 4.1 and 5 million, the research found.

That's in addition to about 6.9 million people who would be subtracted from the ranks of the uninsured under the major coverage provisions of the ACA.

More than half of these people would be in three states: Texas (1.2 million), Florida (877,000), and Georgia (509,000). More than four-fifths of the uninsured people gaining Medicaid eligibility would be adult without children, while about 48 percent of the uninsured gaining eligibility would be white non-Hispanic; 52 percent are working either full- or part-time.

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Groups who would see the largest declines in the uninsured due to expansion -- reductions of 34 percent to 45 percent -- include non-Hispanic blacks, part-time workers, the unemployed and Native Americans/Alaska natives, according to the study.

The ACA has already made a notable improvement in health coverage even in states that have not expanded Medicaid, authors said. If the ACA and state Medicaid expansion decisions continue unchanged, it's projected that 14.6 million people in the 19 states that have not yet expanded Medicaid would be uninsured in 2017, representing 13.9 percent of the nonelderly population.

Those projections are based on recent administrative data on actual Medicaid and marketplace enrollment. The research estimates that without the ACA, 21.5 million would have been uninsured in these states -- 20.4 percent of the nonelderly.

If these 19 states were to expand Medicaid, the number of uninsured would fall to between 9.5 and 10.5 million, depending on success in enrolling the newly eligible. The corresponding uninsured rate would be between 9.1 percent and 9.9 percent, compared to the 13.9 percent rate projected under the ACA without a Medicaid expansion.

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Nearly all new enrollments would be among two groups, the authors said. The first group is composed of the 4.8 million uninsured people estimated to gain eligibility for Medicaid.

The second group was identified as the 2.1 million people with incomes between 100 percent and 138 percent of the federal poverty level who are currently enrolled in the marketplaces, but who would become eligible for Medicaid instead with Medicaid expansion. The remainder of the new Medicaid eligibles already have health coverage outside the marketplaces, nearly all with employer-sponsored health insurance; some will choose to enroll in Medicaid, but based on prior experience, the authors expect that the large majority will not.

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