Nearly 70 Percent of the Uninsured Will Qualify for Assistance in States Expanding Medicaid, Compared to Only 38 Percent in States Not Expanding

10/08/2013 01:55 pm ET | Updated Dec 08, 2013

Now that the open enrollment periods for the new health insurance marketplaces have begun, some observers are asking how many of the uninsured qualify for assistance under Obamacare through Medicaid, the Children's Health Insurance Program (CHIP), or subsidized private coverage.

The answer largely depends on each state's decision to expand Medicaid eligibility. As things stand, 25 states and the District of Columbia are committed to expanding Medicaid, while the remaining 25 states have either decided not to expand Medicaid, or are still in the process of making that decision.

A recent analysis performed by the Urban Institute's Health Policy Center predicts that 68 percent of currently uninsured residents from states that expand Medicaid will be eligible for some type of assistance under the Patient Protection and Affordable Care Act. States that stand to gain the most include Kentucky, Michigan, and West Virginia, each of which would likely see 81 percent of their uninsured residents qualify for assistance.

And as for the states that opt not to expand their Medicaid programs? The analysis predicts that only 38 percent of the residents in these states who are currently without insurance would get coverage under the health reform law. In particular, Texas would see only 34 percent of their uninsured become eligible for assistance.

And with greater eligibility for assistance comes bigger increases in coverage under the health reform law.

Our health insurance simulation model predicted that nine states would see the number of uninsured people cut by more than half. For example, in West Virginia, the number of uninsured is projected to decrease by 57 percent. But in the eight states where less than 40 percent of the uninsured would qualify for assistance, the decline in uninsured ranges from only 28 percent to 32 percent.

On top of that, states committed to increasing health coverage can do even better than what our model projects. For example, many states have made steady progress enrolling more children for coverage in Medicaid and CHIP. The law also gives states an opportunity to simplify and streamline the process that consumers go through when shopping for health insurance.

So how many more could be enrolled? Our model predicts that 46 to 77 percent of residents in states with expanded Medicaid who were simulated to remain uninsured would be eligible for assistance, but not enrolled. Using effective outreach methods, these people could be enrolled in coverage. Just ask Massachusetts.

Obamacare will reduce the number of uninsured in every state, but the size of this reduction is in the hands of each state's elected leaders. The states not currently expanding Medicaid eligibility could roughly double the number of people gaining coverage by doing so.