3.7 Million People Would Gain Health Coverage in 2023 if the Remaining 12 States Were to Expand Medicaid Eligibility

Pedestrians crossing the street within a city crosswalk.

Nearly 4 million people could gain access to healthcare if 12 remaining states expand Medicaid.



The Issue

More than 21 million people nationwide have enrolled in Medicaid because of Affordable Care Act (ACA) expansion opportunities. If Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming expanded eligibility in accordance with the ACA, 3.7 million people would gain access to health coverage next year.

Key Findings

  • Black individuals, young adults, and women—particularly women of reproductive age—would realize the largest coverage gains. 

  • Federal spending on Medicaid and marketplaces in the 12 non-expansion states would be partially offset by $2.6 billion in federal government savings on uncompensated care.
    • State spending on Medicaid in those states would be partially offset by $1.7 billion. 
    • Comprehensive analyses of states that expanded Medicaid demonstrate that expansion generated savings and increased revenues to outweigh any new spending.


Researchers determine that if the current non-expansion states were to expand Medicaid eligibility, there would be a 29 percent reduction in the number of uninsured people. With more people gaining access to health coverage, researchers say there would likely be reduced mortality and improved financial security for many.

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.


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.

View the full infographic