The implementation of Medicaid expansion under the Affordable Care Act (ACA) has resulted in millions of additional Americans gaining high-quality, affordable health care coverage.
To date, 40 states and the District of Columbia have expanded Medicaid, which has extended quality health coverage to more than 23 million people across the country.
The benefits of expanding Medicaid go beyond insurance coverage – expanding the program has been proven to improve health outcomes, provide essential and preventive care, address health inequities, and spur economic growth in local communities.
Expanding Coverage and Improving Health Outcomes
By extending eligibility criteria, Medicaid expansion enables millions of low-income individuals and families to access high-quality, comprehensive health coverage.
Medicaid expansion has led to more continuous coverage for enrollees by reducing administrative disruptions that may impact enrollment. Relatedly, children’s insurance coverage increased when their parents gained coverage, even though the children may have been eligible prior to expansion.
Medicaid expansion has also improved access to care for low-income adults compared to non-expansion states. Following the expansion of Medicaid in Arkansas and Kentucky, people in those two states were more likely to have a personal physician, receive care for chronic conditions, and receive an annual check-up compared to people in states that had not expanded Medicaid, according to a survey. Further, low-income people in states that adopted Medicaid expansion early on were less likely to report that they could not afford medical care or that they delayed medical care due to cost.
Expanding the program is also associated with numerous positive effects for enrollees, including improvements in perinatal mental health among people giving birth, increases in mammogram screening rates, and the prevention of thousands of premature deaths each year.
Extending Medicaid coverage supports early cancer detection. For example, research from 2021 found that colorectal cancer screening rates were higher in expansion states compared to non-expansion states.
Addressing Health Inequities
Expanding Medicaid plays a vital role in addressing health disparities among marginalized and low-income communities.
By extending eligibility to a larger population and making care more affordable, Medicaid expansion provides crucial access to essential preventive services, screenings, and treatments to communities that would otherwise be underserved. The body of research around Medicaid expansion has overwhelmingly shown that expanding Medicaid eligibility contributes to reducing disparities in health coverage.
This is especially true for those living in rural areas, where insurance coverage rates have increased significantly following Medicaid expansion.
Between 2013 and 2015, the Medicaid coverage rate increased from 21% to 26% in states that expanded Medicaid, compared to a 1% increase in non-expansion states. During this same time period, the uninsured rate in rural areas within expansion states fell by nearly half from 16 to 9 percent; largely a reflection of gains in Medicaid coverage in these states. Data shows that expanding Medicaid in rural areas not only increases coverage rates, but has also led to improvements in access to care, such as increased access to mental health care and HIV diagnoses.
Despite this progress, there is more work to be done. In the 10 states that have yet to expand Medicaid coverage, 1.9 million people fall into the coverage gap, which means their incomes are too high to qualify for Medicaid coverage but are too low to qualify for insurance subsidies in the individual health insurance marketplace.
If the remaining states implemented expansion, at least 4 million additional uninsured adults would become eligible for Medicaid coverage. Of these, nearly 60% are people of color. This demonstrates the significant potential for states to further address health disparities by expanding Medicaid.
Spurring Economic Growth
In addition to all the health-related benefits associated with expanding Medicaid coverage, broadening the program’s eligibility requirements has improved the economic well-being of enrollees and local communities. By promoting prevention and improving outcomes for patients, Medicaid makes our citizens, communities, economy, and states stronger.
For new enrollees, studies have shown that increases in health insurance coverage through Medicaid expansion are associated with lower bankruptcy rates and a reduction of medical debt.
The economic benefits of Medicaid expansion are not limited to new enrollees. Previous research has found that Medicaid expansion has resulted in decreases in uncompensated care, increases in operating margins, and decreases in closures of hospitals and obstetric units. Among studies that have evaluated the effect of Medicaid expansion on urban and rural hospitals separately, most reported that improvements in financial performance have been concentrated among rural hospitals.
Moreover, expanding the Medicaid program has improved the financial performances of hospitals and health care providers. Research finds that expansion was tied to lower uncompensated care costs and a decline in medical debt collections, positively impacting health care providers.
Medicaid expansion has reinforced the program’s role as an essential health care safety net. By further expanding eligibility for the program, millions of low-income individuals and families will have access to vital health care services, preventive care, and life-saving treatments.