The Combined Effect of Not Expanding Medicaid and Losing Marketplace Assistance

A judge in his courtroom, in discussion with a professional man.

Researchers explore the combined effect of Supreme Court decisions on Medicaid and insurance marketplace subsidies.

The Issue

If the Supreme Court decides for King in the King v. Burwell case, millions fewer residents would have health insurance in 2016 in the 20 states that decided not to expand Medicaid or take full responsibility for operating their insurance marketplaces under the Affordable Care Act. These 20 states would also miss out on billions in federal funding from 2016 to 2025.  

Key Findings

In total, 9.8 million people in the 20 states would go without insurance in 2016:

  • 4.2 million would have had Medicaid coverage if their state expanded the program.

  • Another 5.6 million would have purchased marketplace insurance, most with the help of federal tax credits.


Researchers additionally find that from 2016 to 2025, these 20 states will miss out on $483 billion in federal Medicaid funding and $238 billion in federal spending on tax credits and cost-sharing reductions to help people purchase health insurance through the marketplaces.

About the Urban Institute

The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic and governance problems facing the nation. For more information, visit Follow the Urban Institute on Twitter or Facebook More information specific to the Urban Institute’s Health Policy Center, its staff, and its recent research can be found at