Pros and Cons of Obamacare: Is It What the United States Needs? HEALTH AND FINANCIAL CONSEQUENCES OF 24 STATES’ DECISION TO OPT OUT OF MEDICAID EXPANSION

Twenty-four states have opted out of expanding Medicaid coverage under the Affordable Care Act. We projected the number of persons who will remain uninsured because of the Medicaid opt-outs and used data from three prior studies to predict the health and financial impacts of the opt-outs. We estimate that as a result of the opt-outs, 7.74 million people who would have gained coverage will remain uninsured. This will result in between 7,076 and 16,945 more deaths than had all states opted-in, as well as 708,195 more persons screening positive for depression, 239,557 more persons suffering catas-trophic medical expenditures, 420,273 fewer diabetics receiving medication, 193,735 fewer mammograms, and 441,260 fewer Pap smears. Many low-income adults will suffer health and financial harms because of their state’s refusal to expand Medicaid coverage. The Affordable Care Act (ACA) was designed to increase access to health insurance by: (a) requiring states to expand Medicaid eligibility to people with incomes less than 138 percent of the Federal Poverty Level (FPL) (US$19,530 for a family of three in 2013), with the cost of expanded eligibility mostly paid by the federal government; (b) establishing online insurance “exchanges ” with regulated benefit structures where people can comparison-shop for insurance plans; and (c) requiring most uninsured people with incomes above 138 percent of FPL to purchase insurance or face financial penalties, while providing premium subsidies for those up to 400 percent of FPL