How has Medicaid expansion affected the disparities in service coverage among racial and income groups in expansion v. non-expansion states?

Learning Goal: I’m working on a policy writing question and need an explanation and answer to help me learn.

The Affordable Care Act (ACA), formally the Patient Protection and Affordable Care Act of 2010, aka “Obamacare” initially included a requirement that state governments expand their Medicaid programs to cover all citizens with incomes that were 138% of the federal poverty level or less. In a 2012 decision, the U.S. Supreme Court decided in a majority vote that Congress had the right to pass the ACA but not the right to demand that state governments expand the program. To date, 38 states plus the District of Columbia have accepted the Medicaid expansion and 12 states have not. The Medicaid expansion paid for the full costs of the newly added enrollees for several years and capped the federal contribution to 90% in 2020. That is, the national government will pay 90% of the costs and the states will pay 10%.

The decision by states to refuse the addition of more persons to their Medicaid roles provides an opportunity for analysts to compare the effects of expansion/non-expansion of Medicaid under the ACA.

The US map shows the expansion and non-expansion states. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/Links to an external site.

The effects of the expansion/non-expansion choice for the states are described in a 2021 issue brief. https://www.kff.org/report-section/building-on-the-evidence-base-studies-on-the-effects-of-medicaid-expansion-february-2020-to-march-2021-report/Links to an external site.

Please look over that brief and answer the following questions:

1. How has Medicaid expansion affected the disparities in service coverage among racial and income groups in expansion v. non-expansion states?
2. Have the costs of Medicaid to the states been higher in expansion states than in non-expansion states? I.e., has Medicaid expansion been costly to expansion state economies?