Public Release: 

Characteristics of patients in states expanding or not expanding Medicaid

The JAMA Network Journals

Low-income uninsured adults in states that opted not to expand Medicaid eligibility as part of the Patient Protection and Affordable Care Act (ACA) appear to have more health-related issues than those uninsured adults living in states that expanded public insurance coverage.

The Supreme Court ruled that under the ACA states cannot be compelled to expand Medicaid. This opened up a coverage-divide beginning in January 2014 with more adults (ages 19 to 64) in 25 states and the District of Columbia (the expansion states) becoming eligible for Medicaid but not uninsured adults in other states that did not expand program eligibility.

The authors sought to examine the characteristics of uninsured adults in expansion vs. nonexpansion states using data from the National Health Interview Survey (2010-202).

In nonexpansion states, low-income uninsured adults were more likely to have delayed or not received health care due to cost, more likely to have had an emergency department visit, and were more likely to smoke, be in fair to poor health, and have several health conditions compared to low-income uninsured adults in expansion states.

"This analysis suggests that low-income adults in nonexpansion states could have more to gain from a Medicaid expansion than those in expansion states. However, these adults will not receive any direct benefit from the expansion unless their state decides to expand Medicaid."


Author: Sandra L. Decker, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues.

(JAMA Intern Med. Published online April 7, 2014. doi:10.1001/jamainternmed.2014.518. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact author Sandra L. Decker, Ph.D., call the National Center for Health Statistics press office at 301-458-4800 or email

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