4.7 Million Uninsured Adults Could Become Eligible for Medicaid by 2021 if All Remaining States Expanded the Program under the ACA

About 4.7 million uninsured adults could gain eligibility for Medicaid by 2021 if the 14 remaining non-expansion states were to expand Medicaid under the Affordable Care Act, a new KFF analysis finds.

That figure includes an estimated 2.8 million adults who already were uninsured prior to the coronavirus pandemic and would fall in the “coverage gap” – meaning they have incomes too high to qualify for Medicaid but too low for ACA marketplace subsidies – as well as 1.9 million more people who are at risk of losing health insurance due to job loss during the pandemic and otherwise would end up in the coverage gap.

An additional 3.3 million adults could become newly eligible for Medicaid coverage instead of ACA marketplace coverage if the remaining 14 states expanded Medicaid. Medicaid is more comprehensive than marketplace coverage and the federal government would pay ninety percent of the bill but that would require additional state expenditures.

Even prior to the pandemic, the potential for covering millions of uninsured people had become the focus of political debate in a number of non-expansion states, including ballot initiatives in Missouri and Oklahoma as well as debate in North Carolina and Kansas. The COVID-19 crisis highlights the implications for the uninsured in states that have not expanded. That is partly due to increased health risks, but also because some people who lose income, jobs and potentially employer-sponsored health insurance amid the pandemic may lack an affordable coverage option that protects against catastrophic health costs and facilitates access to care.

The current economic downturn is the first during which the ACA, including the Medicaid expansion, will be in place as a safety net for people losing their jobs and health insurance. Without it, many more people would likely end up uninsured as the U.S. moves through a recession.