Opting in to the Medicaid Expansion Under the ACA

Medicaid expansion could make insurance coverage available for an additional 7.8 million uninsured adults who are below the age of 35.

At present, few states cover non-disabled, non-pregnant parents with incomes up to 138 percent of the federal poverty level (FPL) and even fewer cover such adults without dependent children. With the implementation of the coverage provisions of the Affordable Care Act (ACA), Medicaid eligibility could increase dramatically for these groups. This report examines who are the uninsured adults who could gain insurance, and how that will affect the states.

Key Findings

  • The 15.1 million uninsured adults who could gain coverage under the ACA Medicaid expansion are a diverse group in terms of their age and race/ethnicity.

  • Just over half (53%) of the uninsured who could gain coverage under the Medicaid expansion are male, but 4.6 million are women of reproductive age.

States are now weighing whether to expand Medicaid under the ACA—some states have expressed concern that expanding Medicaid to more adults may pose fiscal challenges. However, purely monetary calculations ignore the potential human, financial, and productivity benefits associated with improved access to affordable health care for the millions of low-income adults without health insurance coverage and their families.

This report was prepared by researchers at the Urban Institute as part of the Quick Strike Series.

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