Who Is Enrolling in Medicaid Expansion and State Health Insurance Marketplaces

Medicaid Expansion

Many Medicaid expansion enrollees were previously uninsured.

  • According to a Milliman report, over 60 percent of newly eligible individuals were previously uninsured.1

The living situations of those newly eligible for Medicaid are different from those of the traditional Medicaid population.

  • An Urban Institute analysis found that 82.4 percent of the potentially newly eligible population are adults that do not have children or do not live with their children.2
  • According to a Truven Health Analytics white paper, 34.4 percent of those newly eligible are married or cohabitating, compared with 26.7 percent of those previously eligible.3

The newly eligible population has more men than women.

  • Prior to expansion, 34 percent of Medicaid enrollees were male. The newly eligible population is 53 percent male.3

Medicaid expansion enrollees are more likely to be white than prior Medicaid beneficiaries.

  • According to a cross-sectional study, 59 percent of the newly eligible population is white, compared with 50 percent of the Medicaid eligible population previously.4

Medicaid expansion covers people who earn under 138 percent of the federal poverty level (FPL) (about $16,000 for an individual).

  • Over three-fourths of the newly eligible population earns under 100 percent of FPL.2

Medicaid expansion enrollees smoke at higher rates than the general population and past Medicaid enrollees.

  • According to a cross-sectional study, 49.2 percent of the newly eligible population are smokers, compared to 38 percent of current Medicaid beneficiaries.4 Only about 16 percent of Americans of similar age with private insurance smoke.5

The newly eligible population has used health services in the past at a lower rate than current Medicaid enrollees have.

  • In one study, only 35.7 percent of the newly eligible population had seen a general practitioner in the past year, compared with 68.5 percent of Medicaid enrollees.3

Medicaid expansion enrollees are likely to be in better overall health than existing Medicaid beneficiaries.

  • According to a cross-sectional study, 75 percent of the newly eligible population reported themselves to be in excellent/very good or good health. 65 percent of existing Medicaid enrollees reported these health statuses.4

State Health Insurance Marketplaces

During the initial open enrollment period, over 8 million people enrolled in Marketplace plans. They had the following demographics6 :

  • 28 percent between the ages of 18-34
  • 34 percent under the age of 35
  • 54 percent female and 46 percent male
  • 63 percent white, 17 percent African American, 11 percent Latino, 8 percent Asian

Most people enrolling in Marketplace plans have lower incomes

  • During the initial enrollment period, 85 percent of enrollees received financial assistance, meaning they qualified for some level of federal subsidy. Subsidies are available for those making up to 400 percent of the FPL.6

Many people buying coverage through marketplaces have been uninsured previously.

  • According to a Kaiser survey, 57 percent of Marketplace enrollees did not have insurance prior to enrolling in their new plan and most of these people had spent two or more years without coverage.7
  • This same survey also found that 9 percent of Marketplace enrollees had been insured by Medicaid or another public program immediately before purchasing their new coverage.7

People enrolled in Marketplace plans have a similar gender and age distribution to people enrolled in non-Marketplace plans but report worse health.

  • 20 percent of people with Marketplace plans report their health as fair or poor compared to just 6 percent of people who already had health insurance coverage prior to the ACA reporting fair or poor health.7

People enrolled in Marketplace plans are likely to have a higher smoking rate than the general population.

  • In 2012, 29.6 percent of uninsured Americans aged 18-65 smoked, compared to 18.1 percent of the general population.8
  1. Damler, Rob. “Medicaid Expansion under the Affordable Care Act.” Health Watch. October 2013, Issue No. 73. Available at: http://www.milliman.com/insight/2013/Medicaid-expansion-under-the-Affordable-Care-Act/

  2. Kenney, Genevieve et al. “Opting in to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage?” August 2012. Available at: http://www.urban.org/publications/412630.html

  3. Pickens, Gary et al. “Medicaid Expansion: Profiling the Future Medicaid-Eligible Population.” Available at: http://truvenhealth.com/portals/0/assets/HP_11513_0912_MedicaidExpansionEbook_WP_WEB.pdf

  4. Chang, Tammy and Davis, Matthew. “Potential Adult Medicaid Beneficiaries Under the Patient Protection and Affordable Care Act Compared With Current Adult Medicaid Beneficiaries.” Ann Fam Med 2013;406-411. doi:10.1370/afm.1553.

  5. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey Raw Data, 2011. Analysis performed by the American Lung Association Research and Health Education Division using SPSS software.

  6. Department of Health and Human Services. “Health Insurance Marketplace: Summary Enrollment Report For The Initial Annual Open Enrollment Period.” Available at: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf

  7. Hamel, Liz et al. “Survey of Non-Group Health Insurance Enrollees.” July 19, 2014. Available at: http://kff.org/private-insurance/report/survey-of-non-group-health-insurance-enrollees/

  8. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 2012. Analysis by the American Lung Association, Research and Program Services Division.

Page last updated: May 2, 2024

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