Full-Year Health Insurance Coverage Increased for Nonelderly Adults in Medicaid Expansion States Between 2019 and 2022

A patient goes over app-based data with her clinician.

Analyses assess changes between 2019 and 2022 in the share of adults ages 18 to 64 reporting they had continuous health insurance coverage for a full year.


The Issue 

States that expanded their Medicaid programs in accordance with the Affordable Care Act saw a measurable increase in the share of adults with full-year health coverage between 2019 and 2022 while states that did not expand Medicaid saw no measurable change in the share of adults with full-year coverage.

Key Findings

  • The share of adults in expansion states reporting they were insured for the past 12 months was 87 percent in March 2019 and increased to 88.4 percent in June 2022.

  • In the 12 states that have not expanded Medicaid, full-year coverage did not change significantly over the same period: 76.4 percent of adults reported full year coverage in 2019 while 76.2 percent reported it in 2022.

  • Nationwide, 83.4 percent of adults reported full year coverage in 2019 and 84.2 percent reported full-year coverage in 2022.


Researchers note that adults with gaps in health coverage are more likely to miss care they may need and experience worse health outcomes when compared to those with continuous health coverage. 

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.