By Jesse Cross-Call and Matt Broaddus | July 19, 2020

The 35 states (plus the District of Columbia) that have implemented the Affordable Care Act’s (ACA) Medicaid expansion are better positioned to respond to the COVID-19 public health emergency and to prevent the ensuing economic downturn from worsening access to care, financial security, health outcomes, and health disparities. The 15 remaining states should act swiftly to implement expansion to help their residents weather the crisis.

Expansion states entered the crisis with much lower uninsured rates than non-expansion states, due in large part to expansion. That’s important for public health because people who are uninsured may forgo testing or treatment for COVID-19 due to concerns that they cannot afford it, endangering their health while slowing detection of the virus’ spread. Expansion — which provides coverage to non-elderly adults with incomes below 138 percent of the poverty line (about $17,600 for a single adult) — has given Medicaid coverage to over 12 million people. At least 4 million uninsured adults would become eligible for Medicaid coverage if the remaining states expanded, a number likely to increase due to the recession.

Many people who could gain coverage through expansion are those at elevated risk from the virus, whether because they face a high risk of becoming infected or a high risk of serious illness if they do. Expanding Medicaid in the remaining states could cover 650,000 currently uninsured “essential or front-line workers” — those who have jobs that likely require them to show up for work regardless of stay-at-home orders or other restrictions, such as hospital workers, home health aides, and grocery store workers. Prior to the COVID-19 crisis, the uninsured rate for low-income workers in these jobs was 30 percent in non-expansion states, nearly double the rate in expansion states. Expanding Medicaid in the remaining states would also provide coverage to millions of older adults, people with disabilities, and others with underlying health conditions that increase their risk of complications from the disease.

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