How Medicaid Expansion Has Improved Health Equity

Medicaid expansion has played an important role in providing health coverage to a greater number of Americans and helping to reduce racial disparities in health coverage. The implementation of Medicaid expansion under the Affordable Care Act (ACA) has resulted in an additional 16 million Americans gaining high-quality, affordable health care coverage.

Between 2013 and 2018, the gap in uninsured rates between White and Black adults decreased by 51% in states that expanded Medicaid, compared to a 33% reduction in non-expansion states. Further, the gap between non-Hispanic and Hispanic adults in expansion states shrunk by 45%, compared to a 27% decrease in non-expansion states. From 2013 to 2017, the uninsured rates for non-elderly American Indian and Alaska Native adults fell from 31% to 20% in states that expanded Medicaid. Additionally, the coverage disparity between Asian Americans and Whites was eliminated across all income categories since the passage of the ACA through coverage gains within Medicaid, the individual and ACA marketplaces, and employer-provided insurance. As the vast majority of Asian Americans live in Medicaid expansion states, Medicaid has been a primary driver in lowering their overall uninsured rate.

Data also shows Medicaid expansion is leading to better health outcomes for racial and ethnic minorities. A 2018 JAMA study found reductions in mortality from end-stage renal disease were associated with Medicaid expansion. Black patients, who are often at higher risk for kidney failure, saw the largest reduction in mortality. Additional data shows fewer maternal deaths in in states that expanded Medicaid compared to non-expansion states, particularly among Black mothers, underscoring the role of Medicaid in promoting maternal health equity.

As Medicaid’s impact has expanded, states have increasingly moved to Medicaid managed care – a public-private partnership between state governments and health insurance providers to deliver Medicaid benefits – to help narrow the gap in health disparities. Medicaid managed care plans work with states to improve quality and access to care while controlling costs for the nearly 58 million Americans enrolled in managed care plans. Between 2014 and 2018, Medicaid managed care plans improved their performance on 87% of key quality measures related to patient satisfaction, provision of services, and health outcomes.

During the COVID-19 pandemic, Medicaid and managed care waived the cost of all COVID-19 related treatments and care for enrollees — widening access to much-needed care. Managed care plans also took action to expand telehealth services and reduce social barriers to health.

Despite this encouraging progress, there is more work to be done. It is estimated that if the remaining non-expansion states had expanded Medicaid, 4.4 million additional Americans would have had coverage during the COVID-19 pandemic. And in those remaining states, it is estimated that 60% of the individuals who would stand to gain coverage through expansion would come from minority communities.

The COVID-19 crisis has served as an important reminder of the key role Medicaid plays in the fight for health equity. Americans agree – we must ensure Medicaid is strong and stable to continue providing access to essential health care services for underserved and at-risk communities, and improve health outcomes for millions of people – including our families, friends and neighbors.