Health Reform Across the States

A new report by the Robert Wood Johnson Foundation estimates the effects of the Affordable Care Act (ACA) on states, in particular the increases in insurance coverage, subsidies in the exchanges, Medicaid enrollment and federal spending.

The report, written by Urban Institute researchers, uses the Institute’s Health Insurance Policy Simulation Model (HIPSM) to predict results as if ACA were fully implemented in 2011 and contrasts the results with the pre-reform baseline estimates for the year. The results complement an earlier policy brief that analyzed the national impact of the Affordable Care Act.

Among the researchers’ findings:

  • Uninsurance rates among the nonelderly would decrease in all 50 states and in Washington, D.C., ranging from 1 percentage point in Massachusetts to 17 percentage points in Texas.
  • Nationally, 9 percent of the nonelderly would obtain coverage through the new exchanges and just over $33 billion would be spent on premium and cost-sharing subsidies. Subsidies per capita would range from $85 in New England to $142 in West South Central states.
  • The estimated 12 million newly eligible Medicaid enrollees would cost $54 nationally, of which the federal government would pay about $45 billion.
  • There would be $82.3 billion in new federal Medicaid and exchange subsidies flowing to the states, led by California ($9.5 billion), Texas ($8.2 billion) and Florida ($6.7 billion).

The report, by Matthew Buettgens, John Holahan and Caitlin Carroll, features tables and maps detailing ACA outcomes in all 50 states and the District of Columbia.