Medicaid Expansion, Health Coverage, and Spending: An Update for the 21 States That Have Not Expanded Eligibility

Matthew Buettgens, John Holahan, and Hannah Recht
Published: Apr 29, 2015

Table 1: Medicaid Enrollment in 2016 (Thousands)
	Medicaid Enrollment without Expansion				Medicaid Enrollment with Expansion				Difference
	Disabled	Non-disabled Adults	Non-disabled Children	Total	Disabled	Non-disabled Adults	Non-disabled Children	Total	Total Change	Percent Change
Total	4,040	3,627	9,727	17,395	4,086	9,997	10,253	24,336	6,941	40%
Alabama	230	143	346	718	232	408	371	1,011	293	41%
Alaska	18	32	65	115	18	57	65	141	25	22%
Florida	625	526	1,459	2,610	632	1,639	1,527	3,798	1,188	46%
Georgia	322	221	824	1,367	327	798	874	2,000	633	46%
Idaho	41	23	105	168	42	114	115	271	103	61%
Kansas	73	41	155	270	74	162	169	405	135	50%
Louisiana	213	185	459	857	215	474	475	1,164	308	36%
Maine	74	75	79	228	74	134	80	287	60	26%
Mississippi	172	91	296	559	174	285	315	775	216	39%
Missouri	198	148	416	762	201	441	446	1,088	326	43%
Nebraska	38	32	112	181	38	105	118	261	80	44%
North Carolina	337	325	759	1,420	341	811	786	1,937	517	36%
Oklahoma	120	124	356	601	122	317	373	812	211	35%
South Carolina	169	183	383	735	171	424	400	995	260	35%
South Dakota	20	18	61	99	20	57	65	142	42	43%
Tennessee	302	309	603	1,213	303	584	618	1,505	292	24%
Texas	684	444	2,301	3,429	694	1,994	2,457	5,146	1,717	50%
Utah	43	67	153	263	44	179	168	391	128	49%
Virginia	185	144	429	758	187	438	457	1,083	325	43%
Wisconsin	166	485	327	977	166	540	329	1,034	57	6%
Wyoming	11	11	41	63	11	35	43	89	26	42%
Source: Urban Institute Analysis based on HIPSM-ACS, 2015.

Table 2: Number of Uninsured in 2016 (Thousands)
	Number of Uninsured Without Expansion	Number of Uninsured With Expansion	Difference	Percent Difference
Total	14,057	9,789	-4,267	-30%
Alabama	436	259	-177	-41%
Alaska	66	48	-17	-26%
Florida	2,587	1,837	-750	-29%
Georgia	1,249	860	-389	-31%
Idaho	161	103	-59	-36%
Kansas	233	156	-77	-33%
Louisiana	488	295	-193	-40%
Maine	92	52	-40	-44%
Mississippi	332	192	-139	-42%
Missouri	485	294	-191	-39%
Nebraska	128	87	-42	-33%
North Carolina	1,021	709	-313	-31%
Oklahoma	422	295	-127	-30%
South Carolina	490	330	-160	-33%
South Dakota	58	33	-25	-43%
Tennessee	562	383	-179	-32%
Texas	4,076	2,969	-1,107	-27%
Utah	263	195	-68	-26%
Virginia	628	448	-179	-29%
Wisconsin	233	212	-21	-9%
Wyoming	46	32	-14	-30%
Source: Urban Institute Analysis based on HIPSM-ACS, 2015.

Table 3: Medicaid Expenditures, 2015-2024 ($ Billions)
	Federal Expenditures				State Expenditures
	ACA Without Expansion	ACA With Expansion	Difference	Percent Difference	ACA Without Expansion	ACA With Expansion	Difference	Percent Difference
Total	1,551.5	2,023.6	472.1	30%	970.8	1,009.0	38.2	4%
Alabama	56.2	65.0	8.9	16%	26.3	27.3	1.0	4%
Alaska	14.1	17.0	2.9	20%	14.1	14.2	0.1	0%
Florida	206.9	285.2	78.3	38%	145.0	151.1	6.0	4%
Georgia	99.5	147.3	47.8	48%	51.4	55.6	4.2	8%
Idaho	20.8	31.1	10.3	50%	8.2	9.1	0.9	10%
Kansas	29.4	37.8	8.4	28%	22.3	23.1	0.8	4%
Louisiana	74.7	90.0	15.3	20%	47.8	49.3	1.5	3%
Maine	27.0	29.1	2.1	8%	16.8	17.0	0.2	1%
Mississippi	58.0	70.7	12.8	22%	21.4	22.5	1.1	5%
Missouri	87.2	105.1	17.9	21%	53.4	55.3	2.0	4%
Nebraska	19.6	25.1	5.5	28%	16.2	16.6	0.4	3%
North Carolina	146.6	188.3	41.7	28%	76.2	79.0	2.8	4%
Oklahoma	53.0	64.3	11.2	21%	29.8	30.8	1.0	3%
South Carolina	67.6	82.8	15.2	22%	28.2	29.5	1.3	4%
South Dakota	9.2	12.5	3.2	35%	8.0	8.2	0.2	3%
Tennessee	101.0	126.0	25.0	25%	53.7	54.7	1.0	2%
Texas	305.7	433.8	128.1	42%	215.2	228.7	13.5	6%
Utah	26.0	33.5	7.5	29%	11.0	11.7	0.7	6%
Virginia	67.0	90.2	23.2	35%	67.0	69.1	2.1	3%
Wisconsin	75.8	80.7	4.8	6%	52.6	50.0	-2.5	-5%
Wyoming	6.2	8.2	2.0	33%	6.2	6.3	0.2	3%
Source: Urban Institute Analysis based on HIPSM-ACS, 2015.

Table 4: State Spending on Uncompensated Care, 2015-2024 ($ Millions)
	ACA without Expansion	ACA with Expansion	Potential State Savings due to Expansion
			Low (25%)	High (50%)
Total	63,870	44,425	4,861	9,723
Alabama	2,113	1,184	232	464
Alaska	424	251	43	87
Florida	12,545	8,598	987	1,974
Georgia	5,247	3,510	434	868
Idaho	749	551	50	99
Kansas	1,248	850	99	199
Louisiana	2,004	1,257	187	373
Maine	594	365	57	115
Mississippi	1,569	1,064	126	253
Missouri	3,393	2,010	346	691
Nebraska	628	476	38	76
North Carolina	5,406	3,641	441	883
Oklahoma	2,371	1,582	197	394
South Carolina	1,743	1,254	122	244
South Dakota	244	202	10	21
Tennessee	2,672	1,843	207	415
Texas	14,859	11,055	951	1,902
Utah	1,375	1,026	87	174
Virginia	3,089	2,289	200	400
Wisconsin	1,312	1,208	26	52
Wyoming	284	208	19	38
Source: Urban Institute Analysis based on HIPSM-ACS, 2015.

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