The Impact of Current State Medicaid Expansion Decisions on Coverage by Race and Ethnicity

One of the major vehicles in the Affordable Care Act (ACA) to increase health insurance coverage is an expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL). While the expansion was intended to be implemented in all states, as a result of the Supreme Court decision on the ACA, it is now effectively a state choice. Based on an analysis of 2011 American Community Survey data, this brief examines the implications of current state Medicaid expansion decisions on coverage by race and ethnicity. In sum, it finds that people of color will be disproportionately impacted by state decisions to expand Medicaid; the impact of current state Medicaid expansion decisions varies widely by race and ethnicity, with Blacks being at highest risk of continuing to face coverage gaps due to state decisions not to expand at this time; and expansion decisions by a few key states have significant implications for coverage across races and ethnicities.