Matthew Buettgens et al.: Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States:
We first examine how many of the uninsured in each state would be eligible for health coverage assistance programs— Medicaid, the Children’s Health Insurance Program (CHIP) and subsidized private coverage through the new health insurance marketplaces—under the Patient Protection and Affordable Care Act (ACA). The share of the uninsured that is eligible for assistance programs is heavily dependent on a state’s decision whether to expand Medicaid eligibility. Among states not currently planning to expand Medicaid eligibility, the share of the uninsured eligible for assistance ranges from 34 to 53 percent. In contrast, the share of the uninsured eligible for assistance ranges from 59 to 81 percent among the states that are currently committed to expanding Medicaid under the ACA.
Second, we estimate the decrease in the uninsured population under the ACA in each state. Among states not currently expanding Medicaid, we predict the number of uninsured would decrease 28 to 38 percent. Eight states committed to expansion would see the number of uninsured decline by more than half. Other states that have already expanded Medicaid eligibility, such as New York and Vermont, would see smaller reductions in uninsured rates.
Third, we examine the share of those remaining uninsured under the ACA in each state who would be eligible for, but not enrolled in, assistance programs. Among states not currently expanding Medicaid, that share would range from 24 to 43 percent of the post- ACA uninsured. The share is projected to be much higher—46 to 77 percent—among states that are expanding Medicaid.
Fourth, we estimate the share who would qualify for assistance and the expected change in the uninsured in each state, with and without the Medicaid expansion. In all states except Massachusetts, the uninsured are more likely to qualify for assistance if their state expands Medicaid, leading to larger reductions in the uninsured.