States That Expanded Medicaid Saw Steeper Drops in Uninsurance Rates in 2014 and 2015

In states that expanded Medicaid under the Affordable Care Act, the rate of low-income adults lacking health insurance dropped 7.5 percentage points more than the same measure in non-expansion states by 2015, according to an AHRQ study in the May issue of Health Affairs. Researchers analyzed federal survey results for more than 97,000 low-income adults between the ages of 19 and 64 who either lived in states that expanded Medicaid in 2014 or in states that did not expand Medicaid in either 2014 or 2015. While low-income adults in all states gained health insurance between 2013 and 2015, the rate of uninsurance fell by 18.2 percentage points in expansion states and 10.7 percentage points in non-expansion states. Survey respondents in expansion states were also significantly more likely to report that their health insurance coverage was better in both 2014 and 2015, compared to respondents in non-expansion states. Access the abstract.

Medicaid Expansion Coverage Effects Grew In 2015 With Continued Improvements In Coverage Quality

+Author Affiliations

¹Sandra L. Decker (Sandra.decker@ahrq.hhs.gov) is a senior fellow at the Agency for Healthcare Research and Quality, in Rockville, Maryland.
²Brandy J. Lipton is a senior fellow at the Agency for Healthcare Research and Quality.
³Benjamin D. Sommers is an assistant professor of health policy and economics in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.

↵*Corresponding author

Abstract

Previous research has demonstrated large gains in insurance coverage associated with the Affordable Care Act’s (ACA’s) Medicaid expansion in 2014. We used detailed federal survey data through 2015 to analyze more recent changes in coverage for low-income adults after the expansion. We found that the uninsurance rate fell in both expansion and nonexpansion states but that it fell significantly more in expansion states. By 2015 the post-ACA uninsurance rate for low-income adults had fallen by 7.5 percentage points more in expansion than in nonexpansion states, a difference that was similar (about 6.8 percentage points) in adjusted regression models. Private coverage increased in nonexpansion states, but significantly less than Medicaid coverage increased in expansion states. Rates of private coverage did not appear to decline in expansion states. Finally, Medicaid expansion was associated with significantly improved quality of health coverage, as reported by low-income adults.