Analysis Finds the 21 States That Have Not Expanded Medicaid under the ACA Could Expect Substantial Coverage Gains and Increased Federal Funding Were They to Expand

The 21 states that have not expanded Medicaid under the Affordable Care Act would see substantial gains in coverage, decreases in the uninsured and bigger increases in federal Medicaid spending than in state costs should they ultimately decide to do so, according to a newly updated analysis for the Kaiser Family Foundation.

The analysis comes as several states continue to consider whether to adopt a Medicaid expansion, as 30 states (including the District of Columbia) already have. The potential impact on state budgets and health coverage often are key elements of the debate. The analysis provides state-specific estimates for each of the 21 states.  Key findings include:

• If all 21 states expanded, nonelderly Medicaid enrollment would be expected to rise by nearly 7 million. Three states – Texas, Kansas and Idaho – would be expected to see Medicaid enrollment increases of 50 percent or more; 

• Across the 21 states, federal Medicaid spending would rise by an estimated $472 billion from 2015 to 2024, while state Medicaid spending would go up by $38 billion. Idaho and Georgia would see the largest increases in federal spending (50% and 48%) and in state spending (10% and 8%). Alaska and Wisconsin would see declines in state spending; 

• There would be 4.3 million fewer uninsured people. Reductions in the uninsured would be 40 percent or more in 5 states (Maine, South Dakota, Mississippi, Alabama and Louisiana);  

• The amount of uncompensated care from 2015 to 2024, estimated to be $266 billion with no expansion, would fall to $185 billion if all 21 states were to expand. The states would collectively capture between $5 and $10 billion in uncompensated care savings over the 10-year-period. 

As with all of Medicaid, the coverage and budget impacts of the Medicaid expansion would vary across states, with some states seeing greater increases in state costs or coverage than others. The full analysis, conducted by the Urban Institute for the Foundation's Commission on Medicaid and the Uninsured, can be found online at kff.org. 

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.