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

A family returns to their car after a shopping trip.

Stable, affordable health coverage for people in the United States is the starting point to improving health outcomes and building a Culture of Health. In the United States more than 80 million people rely on Medicaid for health coverage—making it the largest healthcare insurance provider in the country.

Despite massive reductions in the number of uninsured Americans as a result of states expanding their Medicaid programs under the Affordable Care Act, 12 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 health care, 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:

  • 2.2 million adults across 12 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."

Read the statement

Featured Content

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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 health care costs, narrowed racial disparities, and provided peace of mind to those who would otherwise have been uninsured.

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Research from the Field

That’s Medicaid: Stories from every state of people covered by Medicaid at critical points in their lives.

State Network: Medicaid Coverage Gap Resources

Closing the Medicaid Coverage Gap Would Help Diverse Group and Narrow Racial Disparities: 2.2 million uninsured adults with incomes below the Federal Poverty Level are caught in the Medicaid “coverage gap.”

Medicaid Explained: A nonpartisan refresher of what congressional staffers need to know about Medicaid.

Balancing Medicaid Budgets and Serving State Residents During A Pandemic: Key factors for state leaders to consider when balancing state budgets and making decisions about funding Medicaid during the COVID-19 crisis.

Health Equity and Medicaid Enrollment: Expanding access to Medicaid is one vital option for improving the health of historically underserved communities.

Status of State Medicaid Expansion Decisions: Interactive Map: Thirty nine states have adopted the Medicaid expansion; 12 states have not.