If the 12 states that have not expanded Medicaid eligibility under the Affordable Care Act did so, 3.7 million people would become insured in 2023. This would reduce the uninsured rate by 29.1%, an August report by the Urban Institute found.

It comes after the Department of Health and Human Services’ announced last week that the national uninsured rate reached a record low of 8% in early 2022.

States have the option to expand Medicaid eligibility to people with incomes up to 138% of the federal poverty level. The states that have not done so are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

Of the 13 states with the highest uninsured rate, 11 have not expanded Medicaid, the Urban Institute said. The 13 states with the highest uninsured rate are Alabama, Arizona, Florida, Georgia, Kansas, Mississippi, Nevada, North Carolina, South Carolina, South Dakota, Tennessee, Texas and Wyoming. The only non-expansion state that is not in the group with the lowest uninsured rate is Wisconsin, which extended Medicaid eligibility to adults with incomes up to 100% of the federal poverty level without the ACA.

The report used a simulation model of the healthcare system that estimated the cost and coverage effects of proposed healthcare policy options.

“Growing evidence shows that increased health coverage lowers mortality and increases the financial security of families with low incomes,” the report stated. “It can also decrease the number of unwanted pregnancies and increase access to effective contraception, which is particularly important after the Supreme Court’s decision revoking the constitutional right to an abortion. Medicaid expansion also improves hospital finances and can boost state economies.”

Here are additional findings from the Urban Institute’s report:

• With the expansion, Medicaid enrollment would increase by 6.4 million people, or 35.9%. The states that would have the largest increases would be Wyoming at 65.4%, Florida at 42.6% and Kansas at 42.2%.
• The populations that would benefit the most are Black people, young adults and women, especially those of reproductive age. If the 12 states expanded Medicaid, the number of uninsured Black people in those states would decrease by 46.1%, the number of uninsured young adults would fall by 35.2% and the number of uninsured reproductive age women would decline by 36.2%.
• Federal spending on Medicaid and Marketplaces in the non-expansion states would rise by $34.5 billion, or 26.6%, though it would be partially offset by $2.6 billion in federal government savings on uncompensated care.
• On the state side, spending on Medicaid in the non-expansion states would grow by $2.7 billion, or 5.2%. But it would be partially offset by $1.7 billion in state and local government savings on uncompensated care.
• Despite these costs, savings would be made in other areas from Medicaid expansion. For example, states would save on uncompensated care and would receive higher matching rates for some beneficiaries, and tax revenue would increase.

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