For States That Opt Out of Medicaid Expansion: 3.6 Million Fewer Insured and $8.4 Billion Less in Federal Payments

Since US Supreme Court’s ruling on the ACA that allowed states to opt out of the health reform law’s Medicaid expansion, fourteen governors have announced that their states will not expand their Medicaid programs. This paper’s authors used the RAND COMPARE microsimulation to analyze how opting out of Medicaid expansion would affect coverage and spending, and whether alternative policy options—such as partial expansion of Medicaid—could cover as many people at lower costs to states. They concluded that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.