Parents  smiling while holding their toddler.

Providing needed access to healthcare for one in five people in the United States.

Despite massive reductions in the number of uninsured Americans as a result of states expanding their Medicaid programs under the Affordable Care Act, 11 states have not expanded eligibility, denying health coverage to more than 2 million people. These people disproportionately come from communities of color and fall into what is known as the Medicaid “coverage gap.”

Although many people in the coverage gap are employed, they are less likely to have jobs that offer health insurance—this includes more than half a million essential workers. Many make too much money to be eligible for traditional Medicaid, but not enough to afford the cost of health insurance they purchase themselves. As an example, a single person in Texas who makes $10,000 a year doesn’t qualify for Medicaid, even though purchasing health insurance would cost more than half their salary.

Closing the Medicaid coverage gap is the single biggest action the country can take to reduce the number of uninsured. The refusal of some states to expand their Medicaid programs means that political considerations are being prioritized over healthcare, even in the midst of the ongoing COVID-19 pandemic where health insurance can be the difference between life and death.

The case for closing the Medicaid coverage gap:

  • 2.1 million adults across 11 states fall into the Medicaid coverage gap and are unable to access affordable, comprehensive health insurance because those states have refused to expand their Medicaid programs.
  • 60 percent of individuals in the coverage gap are people of color.
  • More than 550,000 essential workers fall into the Medicaid coverage gap.
  • Expanded Medicaid coverage has saved lives, reduced out-of-pocket costs, narrowed racial disparities, and provided peace of mind to those who would otherwise be living without insurance.
  • The average reduction in medical debt among people gaining coverage through Medicaid expansion is approximately $1,140.
  • Healthcare providers in states that expanded Medicaid saw a 45 percent drop in the cost of uncompensated care, which benefits their local economies.

Joint Statement Strongly Supports Congress Permanently Closing the Medicaid Coverage Gap

RWJF and public health and racial justice advocates state that, "in a country as wealthy as the United States, it is unconscionable that a person’s access to healthcare often comes down to skin color, gender, income, geography, disability, and employment or immigration status."

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Closing the Medicaid Coverage Gap is a Health, Economic, and Moral Imperative

Closing the Medicaid coverage gap would save lives, reduce health care costs and help eliminate the racial and ethnic health disparities that have persisted for generations.

Financial barriers to care, particularly for people of color or those in low-wage jobs, is one of our nation’s clearest vulnerabilities. The Medicaid program is a critical lifeline for individuals in historically underserved communities and vital for improving the health of the nation.

Avenel Joseph, PhD, vice president, Policy

Medicaid Expansion is a Win for All

Expanded coverage has saved lives, reduced healthcare costs, narrowed racial disparities, and provided peace of mind to those who would otherwise have been uninsured.

Research from the Field