If States Keep Resisting Medicaid Expansion, Two-Thirds Of Eligible Americans Won’t Get Coverage

Nearly two out of three low-income Americans who are eligible for Medicaid coverage under Obamacare may not actually get those health benefits next year, according to a new analysis from the Associated Press. Those people are likely to miss out because states across the country are still refusing to expand the public insurance program.

Since each state may now decide whether or not to participate in Obamacare’s Medicaid expansion, the health law’s goal of extending coverage to 30 million uninsured Americans has been thrown into question. Drawing on figures from the Urban Institute, the AP finds that 9.7 million of the 15 million adults who qualify for Medicaid coverage under the expansion live in states that are refusing to implement that policy.

And as GOP-led states — including those with especially high rates of uninsurance — continue to indicate that they won’t participate in the expansion, health policy experts warn that the country will see a wide range of health disparities across different regions.

“Because of the Supreme Court’s decision making Medicaid expansion optional with the states, we’re going to see some pretty significant differences in this country from one place to another in terms of access to health care and access to health insurance,” Gary Cohen, the Health and Human Services official overseeing Obamacare implementation, explained.


Fortunately, some of the low-income Americans who would have otherwise qualified for Medicaid coverage will have other options to get the health care they need. Many of them will be eligible for subsidies that will help them purchase a health plan on Obamacare’s state-level insurance marketplaces.

But that won’t be an option for everyone who lives in a state that’s refusing to expand Medicaid. Under the health law, Medicaid coverage is the only option for the very poor Americans whose incomes fall below the federal poverty level. And without the expansion, some states’ restrictive Medicaid requirements actually cut off access to public insurance for some of those extremely needy people.

“This decision will have very real human costs for the adults who are going to remain uninsured and their families,” Genevieve Kenney, the co-director of the Urban Institute’s health policy center, told the Associated Press. “It seriously undermines the ability of the Affordable Care Act to substantially reduce the number of uninsured in this country, at least at the beginning.”