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Nearly four and a half million low-income Americans who were looking for coverage during Obamacare’s open enrollment period have gained access to public health insurance under the law’s expansion of Medicaid, according to datafrom the Health and Human Services Department. Enrollment in Medicaid or the Children’s Health Insurance Program (CHIP) spiked by about eight percentin the states that accepted Obamacare’s expansion — a significantly higher rate than in non-expansion states, where the enrollment figures rose by less than two percent over the same time period.


The most recent report from the Centers for Medicare & Medicaid Services (CMS) is an incomplete snapshot of Medicaid enrollment. Not every state has submitted its data, and the report only goes through the end of February. CMS also cautions that its data, which includes people who are re-enrolling in Medicaid, doesn’t only represent the people who have newly become eligible under expansion.

Still, the agency explains that reforms under Obamacare have helped spur the jump in enrollment over the five month period. “Changes in eligibility and enrollment processes ushered in by the Affordable Care Act…are in effect in all states and are likely to promote coverage among previously eligible but uninsured adults and children,” the report explains.

For instance, health policy analysts believe Obamacare has had a “woodwork effect” — essentially, helping to raise awareness about people’s health insurance options, and therefore encouraging uninsured Americans to come out of the woodwork to sign up for Medicaid. Even though those people were already eligible for coverage before the Affordable Care Act kicked in, they may not have realized it. That’s why Medicaid enrollment is ticking up even in the states that have rejected Obamacare’s expansion.

And in order to ease the implementation of the Medicaid expansion, CMS recently streamlined the process that states may use to sign up low-income Americans. Now, states can rely on the data for other government programs, like the supplemental nutritional assistance program (SNAP), to more easily identify additional residents who would qualify for Medicaid. Five states — Arkansas, California, Illinois, Oregon, and West Virginia — have seen big jumps in enrollment after putting this policy into practice. Between the five of them, they’ve identified nearly half a million poor Americans who are eligible for public insurance. That’s been particularly impactful in West Virginia, which had an especially high uninsurance ratebefore Obamacare went into effect.

Although it’s not yet clear how many previously uninsured Americans are gaining coverage for the first time under Obamacare, HHS reports that 4.4 million people were deemed eligible for Medicaid and CHIP after shopping on Obamacare’s exchanges during the open enrollment period. Outside estimates have come to similar conclusions, suggesting that about 4.5 million low-income people have gained Medicaid coverage thanks to the health reform law. The expansion of the public program for poor Americans has been one of the Affordable Care Act’s biggest success stories.

Tara Culp Ressler 150

But those success stories aren’t being shared equally across states. The areas where Americans struggle most to afford health insurance have refused to accept Obamacare’s Medicaid expansion, leaving about 5.8 million impoverished people without any access to coverage.

Tara Culp-Ressler

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