The purpose of this study is to compare the US states that have adopted the Affordable Care Act’s (ACA) Medicaid Expansion to the states that have not done so. The Medicaid Expansion makes people with incomes up to 138 percent of the federal poverty (FPL) line eligible for Medicaid. The US Supreme Court ruling in June 2012 made the Medicaid Expansion, originally intended to be nationwide, optional for states. To date, 37 states and the District of Columbia have implemented this Expansion.

We compare a group of states that adopted the Medicaid population, excluding a few states that had, pre-ACA, already covered most or all of this Expansion population, to those states that had not adopted this Expansion through the end of 2019. We compare these groups of states across the Medicaid Expansion timeframe that was available for analysis (typically 2014-2019). Some of the key components of our assessment included:

• Health Coverage — particularly impacts on the size of the uninsured population

• Medicaid Costs – overall and at the state and federal level

• Deaths in the under-65 population

• Employment Levels and Unemployment Rates

This study is an objective analysis of the observed impact of Medicaid Expansion on the number of uninsured, Medicaid costs to both states and the federal government, deaths, employment, hospitals’ financial situation, and other key outcomes. The intent is to help inform the states that have not yet implemented the Expansion about its likely impact, as well as to demonstrate for Expansion states the aggregated impacts that have occurred.