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Expanding Medicaid in Holdout States Could Insure 3.9 Million

MONDAY, Aug. 10, 2020 -- Expanding Medicaid to all states could reduce the number of uninsured by 28 percent based on pre-COVID-19 data, according to a report released by the Urban Institute and the Robert Wood Johnson Foundation.

Michael Simpson, from the Urban Institute Health Policy Center, and colleagues used the pre-COVID-19 current-law baseline to estimate the effects of expanding Medicaid on health insurance coverage and government costs in each of the 15 nonexpansion states in 2020.

The authors note that if these 15 states were to have fully implemented a Medicaid expansion in 2020, there would be a 28 percent reduction in the uninsured (3.9 million fewer people). An additional 185,000 people would gain more comprehensive insurance by dropping short-term limited-duration plans and enrolling in Medicaid, yielding 4.1 million more people having coverage meeting Affordable Care Act standards. In these 15 states, federal spending on health care for nonelderly people would increase by about $30.4 billion (a 23 percent increase), while state spending on Medicaid in these states would increase by $4.7 billion (9 percent) but would be fully or largely offset by savings in other areas.

"Given the COVID-19-related job losses, the largest number since the Great Depression, employer-sponsored insurance is lower than the current law estimates presented here and is likely to fall significantly further," the authors write. "As a consequence, these estimates of the implications of Medicaid expansions in the remaining states understate the increase in coverage and government spending that would occur, at least in the near term."

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Posted: August 2020

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