The Implications of Medicaid Expansion in the Remaining States

A counselor meets with a client about health services.

Analysis looks at what would happen if remaining 19 states that have not expanded Medicaid did so.



The Issue

There are 19 states that have not expanded Medicaid under the Affordable Care Act. If these states expanded Medicaid coverage, they would see increases in their insured populations, a reduction in uncompensated care costs, and increased state spending fully or largely offset by savings in other areas.

Key Findings

If the 19 nonexpansion states expanded Medicaid:

  • 4.5 million more people would have health coverage in 2019;

  • The uninsured rate in those 19 states would drop from 16.9 percent to 12.6 percent;

  • Demand for uncompensated care would decrease by $8 billion.


Expansion of Medicaid would increase the number of people who have insurance benefits in these 19 states. The 32 states that have already expanded the program have fewer uninsured residents, lower uncompensated care costs, and experienced net gains in state budgets.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.