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

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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