Expanding Medicaid eligibility in GA would reduce uninsurance by 28%

Expanding Medicaid eligibility in Georgia would help reduce uninsurance among non-elderly individuals by almost 300,000 people, according to a report from the Urban Institute and the Robert Wood Johnson Foundation.

Georgia is one of the ten states that have yet to expand Medicaid eligibility under the Affordable Care Act (ACA) to people with incomes up to 138 percent of the federal poverty level (FPL).

The report expands on earlier results from 2023 and uses the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to assess how Medicaid expansion would impact Georgia residents and their insurance status.

Researchers found that Medicaid expansion would decrease uninsurance in Georgia by almost 28 percent, with 293,000 non-elderly individuals gaining coverage. The uninsurance rate would fall from 10.9 percent to 7.8 percent.

The findings predicted that Medicaid enrollment would grow by 671,000 people, with more than 300,000 people with subsidized marketplace coverage switching to Medicaid. Only around 69,000 people would leave their employer-sponsored plan to join Medicaid, accounting for 10 percent of the Medicaid growth.

The uninsurance rate among people with incomes below 138 percent of FPL would fall from 19.2 percent to 9.6 percent, while Medicaid enrollment would grow from 1.5 million to 2.2 million, marking a 45 percent increase.

Researchers projected that a small number of people with incomes above 138 percent of FPL would leave their private non-group coverage, as the shift of lower-income people from non-group to Medicaid may increase the risk in the remaining non-group pool and raise premiums.

Health insurance increases would be most prominent for adults between 19 and 34; the uninsurance rate is projected to fall by more than 35 percent. Young adults are the most likely age group to lack health insurance before and after Medicaid expansion. Around 25 percent of uninsured people 35 and older would gain coverage.

When looking at race and ethnicity, over 120,000 Black non-Hispanic and White non-Hispanic people would gain coverage following Medicaid expansion. The relative reduction would be highest among Black non-Hispanic people, with uninsurance falling by 44.5 percent. Uninsurance would decline by 38.0 percent for American Indian and Alaskan Native people, 31.5 percent for White non-Hispanic people, 13.6 percent for Asian and Pacific Islanders, and 10.9 percent for Hispanic people.

Men in Georgia are more likely to be uninsured with or without Medicaid expansion compared to women, but slightly more men would gain coverage after Medicaid expansion, the report noted.

The American Rescue Plan Act of 2021 includes a financial incentive for states that expand Medicaid. If Georgia implemented expansion in 2024, around $0.6 billion in Medicaid spending would shift from Georgia to the federal government in 2024 and 2025, offsetting any increase in state Medicaid spending.

Over the next ten years, federal spending would increase by almost $37 billion, while net state spending would rise by $1.5 billion. Federal spending on Medicaid in Georgia would grow by over $60 billion but would be offset by reduced spending for marketplace subsidies totaling -$22.5 billion. In addition, federal and state governments may see less demand for uncompensated care due to fewer uninsured people.

After implementing Medicaid expansion, Georgia would go from having the 8th-highest uninsurance rate of all states to the 24th-highest. Past research has also found that Medicaid expansion is associated with decreased mortality, better financial security, and more stable hospital finances.