Obamacare’s Medicaid Expansion Slashed The Uninsured Rate — And The GOP Wants To Take It Away Repealing The Affordable Care Act Would Undo Gains For Poor Families Across America

The Affordable Care Act’s chief aim is to extend coverage to people without health insurance. One of the 2010 law’s primary means to achieve that goal is expanding Medicaid eligibility to more people near the poverty level.

But a crucial Supreme Court ruling in 2012 granted states the power to reject the Medicaid expansion, entrenching a two-tiered health care system in America, where the uninsured rate remains disproportionately high in mainly Republican-led Southern and Southwestern states.

Now, President Donald Trump and the Republican-led Congress are moving to repeal the Affordable Care Act and its Medicaid expansion, which would reverse historic gains in health coverage across the country.

A Tale Of Two Americas

The states that expanded Medicaid already had a lower combined uninsured rate than the states that didn’t, and the gap has widened since then.

States that undertook the expansion experienced significantly larger increases in the share of their residents with health coverage, compared to states that rejected the expansion and relied only on federally subsidized private health insurance from the exchange marketplaces to expand coverage. From 2013 to 2016, the uninsured rate fell 48 percent in expansion states and 28 percent in states that opted out of the Medicaid expansion.

Expansion states 2013 15.8% uninsured 2016 8.2% Non-expansion states 2013 20.2% 2016 14.5% Source: Gallup-Healthways Well-Being Index, February 2017. The margin of sampling error is ±0.2 percentage points, 19 times out of 20.

In non-expansion states, people below the poverty level get no help, because private insurance subsidies are available only to people who earn more than that.

If the Affordable Care Act were repealed, the national uninsured rate would rise, a trend that would hit hardest in those states that had more uninsured before the law.

Where Your State Stands

Between December 2013 and December 2016, the national uninsured rate fell from 17.3 percent to 10.8 percent. The decrease is much greater in states that expanded Medicaid, and the gap between the top and bottom states has grown.

Gallup reported the percentage of population uninsured throughout 2016 in states that expanded and did not expand Medicaid. For comparison, we added 2013 percentages for each state. (All states' uninsured percentages dropped between 2013 and 2016.) Smallest Percent Uninsured Hawaii 3.2% Massachusetts 3.2% Iowa 3.9% Minnesota 5.6% Vermont 6.1% West Virginia 6.1% Connecticut 6.2% Wisconsin 6.2% Pennsylvania 6.3% North Dakota 6.9% Michigan 7% New York 7% Rhode Island 7% Washington 7.2% Maryland 7.3% Ohio 7.4% New Hampshire 7.6% Illinois 7.7% Kentucky 7.8% Delaware 8% Indiana 8.6% New Mexico 9% Maine 9.1% Oregon 9.1% Colorado 9.3% Largest Percent Uninsured Texas 20.5% Mississippi 17.2% Oklahoma 16.3% Georgia 15.6% Florida 14.6% Idaho 14% North Carolina 13.6% Alabama 13.6% South Carolina 13.1% Wyoming 12.9% Louisiana1 12.5% Kansas 12.3% Tennessee 11.8% Alaska 11.7% Montana 11.3% Nevada 11.2% Nebraska 11.2% Arizona 11% California 10.5% Missouri 10.4% Arkansas 10.2% South Dakota 9.9% Virginia 9.8% Utah 9.7% New Jersey 9.3% Source: Gallup-Healthways Well-Being Index, February 2017. The margin of sampling error is ±1 to ±2 percentage points for most states, but as high as ±3.5 percentage points for states with low populations like North Dakota, Wyoming, Vermont and Alaska.

The History Of The Medicaid Expansion

Medicaid is a health care program created in 1965 for low-income people. It is jointly managed and financed by the federal government and the states. Nearly 69 million Americans were enrolled in Medicaid as of November 2016.

Medicaid mainly covers children, pregnant women, some parents of poor kids, people with disabilities and elderly nursing home patients. Before the Affordable Care Act, adults who had no children living at home or who didn’t have a disability usually were excluded, no matter how poor they were.