State borders have become dividing lines that determine whether many Americans have access to Medicaid health insurance coverage. As of 2019, 36 states have expanded Medicaid to include more low-income individuals with household incomes up to 138 percent of the federal poverty level through the Affordable Care Act, ballot measures, legislation, or Medicaid Waiver applications.
Opponents of expansion claim that expansion drains state resources, increases taxpayer costs, and can be a “real budget-buster.” However, research indicates that this is not the case. Studies have shown that Medicaid expansion states experienced significant increases in coverage and reductions in uninsured rates among low-income populations; improved access to care, utilization of services, the affordability of care, and financial security among the low-income population. Additionally, these studies show state budget savings, revenue gains, and overall economic growth. A recent study from the University of Michigan found that Medicaid expansion substantially reduced mortality rates from 2014 to 2017.
Notably, Medicaid expansions lower health care costs by increasing access to regular medical appointments and diagnosing illnesses in early stages. For example, Patricia Powers, a minister in St. Louis County, Missouri, lost access to health insurance in 2012 when her husband became disabled. Her family earned too much to qualify for Medicaid in Missouri, a non-expansion state, and too little to qualify for subsidies on the federal health care marketplace, so she could not afford to purchase a plan. Without insurance, Powers did not see doctors for routine health visits for years, and after visiting a clinic in 2016, discovered that she had breast cancer. If she had had access to health insurance, Powers may have been able to be diagnosed and begin treatment earlier, resulting in lower health care utilization and lower costs.