A Golden Opportunity for Expanding Health Care

By Lena O’Rourke

Despite recent attempts to repeal it, the Affordable Care Act (ACA) is here to stay, including the option for states to expand Medicaid to millions of low-income workers who had previously been left out from both public and private health coverage. This means the 31 states (and D.C.) that have already expanded Medicaid can continue to do so, and the remaining states have a perfect opportunity to cover more uninsured people. This is an important moment to understand the effects of the Medicaid expansion and how it has improved access to care 

The Urban Institute released a new studyThe ACA Medicaid Expansion Led to Widespread Reductions in Uninsurance Among Poor, Childless Adults (April 2017)that paints a clear picture how expansion has benefited working age childless adults. Prior to the ACA, adults without children – including non-custodial parents and people with grown children – rarely qualified for Medicaid unless they were receiving disability benefits. (Low-income working parents also obtained new access to Medicaid coverage through expansion.) The report also describes how Medicaid increases access to health insurance for low-income adults in poor health who have few options for coverage.  

Not surprisingly, the study found the states that expanded Medicaid saw dramatic reductions in the rates of uninsured childless adults, dropping dramatically from 45.4 percent in 2013 to  16.5 percent in 2015. For comparison, the rate of uninsured childless adults was 47.8 percent in non-expansion states in 2015.  

The report found that among childless adults who described themselves as in fair or poor health, the ACA Medicaid expansion reduced the uninsured rate by 21.2 percentage points, or 61.7 percent, compared with the pre-ACA level. This suggests that the expansion reached individuals who needed health insurance but previously had limited access to coverage. It is also possible to infer the reverse: in nonexpansion states, a large group of poor childless adults with significant health issues do not have access to affordable coverage and are likely forgoing needed care.  

Other research by the Kaiser Commission on Medicaid and the Uninsured has shown the overall uninsured rate fell for all racial and ethnic groups—and that the declines were larger among people of color, with particularly large decreases among Hispanics. The Kaiser Commission’s research also shows that uninsured Black adults are more than twice as likely as White and Hispanic uninsured adults to fall into the coverage gap since a large share of this population resides in the South where many states have not yet expanded Medicaid.  

These findings have profound implications for advocates and policymakers.  

The lesson for nonexpansion states is simple: expand Medicaid, which brings needed federal resources into the states and results in a dramatic decrease in the state’s uninsured rate, including for communities of colorThe Affordable Care Act will remain the law of the land, and this is a pivotal time for the remaining 19 states to expand Medicaid.  

More broadly, the study also underscores the importance of protecting Medicaid expansion for low-income adults, and particularly those in fair or poor health. These individuals have few options for health insurance or access to the treatments and services they need to heal or maintain their healthThe expansion provides affordable insurance to childless adults who need health services. The 61.7 percent drop in the uninsured rate among adults in poor health demonstrates a population who needs access to care. Policymakers should keep these individuals in mind when crafting policy. 

Eliminating the Medicaid expansion or placing obstacles, whether work requirements or burdensome paperwork, in the path of people seeking health coverage will take insurance away from poor, sick adults. These individuals will likely end up uninsured and in the “coverage gap” with few affordable options. Health insurance, including Medicaid, makes it possible for people to get their medicines, receive treatment, and become healthy and productive members of society. With the continued public attention on the importance of affordable health care, now is the right moment to expand coverage.