Medicaid Expansion under the ACA


Under the Affordable Care Act, health insurance coverage increased. Between 2010 and 2015, the uninsured rate among women ages 18 to 64 decreased from 19.3 percent to 10.8 percent, a relative reduction of 44 percent.

As of 2016, national enrollment in Medicaid has grown to 75.2 million from 57.7 million in 2013, or total growth of 17.6 million (31%). Nine states have posted over 50% growth, with Nevada just shy of doubling at 97%, Colorado 89%, Montana 82%, Kentucky 73%, and California up 71%.

Medicaid is the nation’s largest insurer. It is the centerpiece of the U.S. health care safety net, providing benefits to adults and children who would otherwise have difficulty getting and paying for care. Yet the program is not well understood by the public

  • Nearly 16 million people have gained Medicaid coverage under the Affordable Care Act’s expansions; most had previously been uninsured
  • Most people are satisfied with their Medicaid coverage. A recent Commonwealth Fund survey found that 88 percent of adults are satisfied with their new Medicaid coverage: 77 percent rate it as either good, very good, or excellent (Exhibit 2). These ratings have remained consistent since 2014, when states began expanding their programs
  • Medicaid helps people get care and improve their health.
  • Medicaid provides access to timely care.
  • Medicaid provides comprehensive benefits and financial protection from large medical bills.

Did you know?

A “block grant” is a fixed amount of money that the federal government gives to a state for a specific purpose.

The Republicans propose that the Federal Government would fund Medicaid as a block grant. Counter to what proponents claim, block grants don’t give states more flexibility with their Medicaid programs.

What does this mean for state Medicaid expansion?

The federal government would set each state’s Medicaid spending amount in advance. That amount would be based on some estimate of state Medicaid spending.  This would mean a significant cut in federal Medicaid support and an increase in state funding.  Most states would meet this need by limiting eligibility.

Overall, hospitals in Medicaid expansion states saw increased Medicaid discharges, increased Medicaid revenue, and decreased cost of care for the poor, while hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue, and growth in cost of care to the poor

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