Image by Lauren Friedlander / COURIER.
Image by Lauren Friedlander / COURIER.

More than 2 million people, however, remain unable to access care because they live in states that have not expanded Medicaid coverage.

In case you hadn’t heard: and other state health insurance marketplaces opened for business on Nov. 1, allowing Americans without private insurance to apply for coverage for 2020. 

While the federal government has made publicizing open enrollment less of a priority in recent years—the US Centers for Medicare & Medicaid Services spent $10 million in 2017 to promote Affordable Care Act (ACA) open enrollment, a $90 million cut from the previous year—states, health organizations and lawmakers are stepping up. For example, 17 Democratic senators partnered with patient advocate Peter Morley to produce a video toting the importance of getting coverage.

Even former President Obama is working to get the word out. On Friday, he tweeted: “Today’s the first day of open enrollment on, and high-quality coverage might be more affordable than you think. Nearly 9 in 10 customers qualify for financial help—so if you or someone you know needs insurance, #GetCovered today.”

For many people, however, an affordable option for health care remains out of reach. Currently, 14 states have not adopted the Medicaid expansion under the ACA. In other words, several states have turned away federal funding that would essentially allow more of their residents to access health care. 

According to Kaiser Family Foundation, that means 2.5 million adults remain uninsured in places like North Carolina, Georgia, Wisconsin, Missouri and others because their lawmakers have not voted to expand Medicaid coverage. 

Most of the people in this coverage gap are adults without children, such as Jasmin Stiger. Before moving to Texas recently, she lived in Georgia and applied for Medicaid coverage after she stopped working because of poor health. Even though she had zero income at the time, her application was denied because she’s not disabled and does not have any children. “Where do I fit in?” she told COURIER. “What makes me so different that I can’t get some kind of health care?”

In 2018—for the first time since the ACA was implemented—the number of people who went without health insurance went up. Last year, 27.5 million people did not have access to health coverage, an increase of 7.9 percent from the previous year. Experts say that the drop in enrollment could be due to a number of factors, including the repeal of the individual mandate.

It’s clear, however, that if all states expanded Medicaid, as the original ACA bill envisioned, more people would be able to get the care they need. 

Here’s an estimate of how many non-elderly adults could benefit if these remaining states voted to expand Medicaid coverage:

North Carolina: 379,000

South Carolina: 211,000

Georgia: 457,000

Florida: 837,000

Alabama: 223,000

Mississippi: 163,000

Texas: 1.4 million

Oklahoma: 196,000

Kansas: 80,000

Missouri: 219,000

South Dakota: 29,000

Wyoming: 20,000

2020 open enrollment ends Dec. 15.