The Centers for Medicare & Medicaid Services (CMS)—a federal agency  within the Department of Health and Human Services (HHS)—and states  jointly administer and fund the Medicaid program. 1.) As of December 2017, 31 states and the District of Columbia had  expanded Medicaid eligibility to the new coverage population allowed  under PPACA and 19 states had not. Survey Estimates Showed 5.6 Million Uninsured, Low- Income Adults Had Qualifying Incomes for Expanded Medicaid Coverage

According to the NHIS estimates, 5.6 million low-income adults were  uninsured in 2016. NHIS estimates also showed that over half of uninsured, low-income  adults were male, over half were employed, and over half had incomes  less than 100 percent FPL. 3.) Survey Estimates Showed Low-Income Adults in Expansion States and Those Who Were Insured Were Less Likely to Report Financial Barriers to Health Care

The 2016 NHIS estimates showed that smaller percentages of low- income adults in expansion states reported financial barriers to needed  health care compared with those in non-expansion states; and smaller  percentages of those who were insured reported financial barriers to  needed health care compared with those who were uninsured, regardless  of where they lived, for example:
Low-income adults in expansion and non-expansion states. Survey Estimates Showed Low-Income Adults in Expansion States and Those Who Were Insured Were Generally More Likely to Report Having a Usual Place of Care and Receiving Selected Health Care Services

The 2016 NHIS estimates showed that a larger percentage of low-income  adults in expansion states reported having a usual place of care  compared with those in non-expansion states; and larger percentages of  those who were insured reported having a usual place of care compared  with those who were uninsured, regardless of where they lived, for  example:
Low-income adults in expansion and non-expansion states. Access to Health Care: Having a Usual  Place of Care  The 2016 National Health Interview Survey  (NHIS) asked respondents about whether  they had a place they usually go when sick or  need advice about their health. 7.) HHS provided  technical comments, which we incorporated as appropriate. Appendix I: Objectives, Scope, and Methodology

To describe national survey estimates of (1) the number and  demographic characteristics of uninsured, low-income adults in expansion  and non-expansion states; (2) unmet medical needs for low-income  adults in expansion and non-expansion states and by insurance status;  (3) barriers to health care for low-income adults in expansion and non- expansion states and by insurance status; and (4) having a usual place of  care and receiving selected health care services for low-income adults in  expansion and non-expansion states and by insurance status, we used  data from the 2016 National Health Interview Survey (NHIS). We selected these  survey questions and composite measures from the Family and Adult  Access to Health Care and Utilization and Adult Health Behaviors  sections of the 2016 NHIS. We determined that the data  were sufficiently reliable for the purposes of these analyses. The table provides estimates for these adults based  on whether they resided in states that expanded Medicaid eligibility as  permitted under the Patient Protection and Affordable Care Act (PPACA)  (referred to as expansion states) or states that did not (referred to as non- expansion states). Estimates are based on a  composite measure of any unmet medical needs. We also  report any statistically significant differences when comparing the six  groups of low-income adults, specifically:  low-income adults who were uninsured in expansion states compared  with each of the four groups of low-income adults who were insured— low-income adults who had Medicaid in expansion states, low-income  adults who had Medicaid in non-expansion states, low-income adults  who had private health insurance in expansion states, and low-income  adults who had private insurance in non-expansion states;  low-income adults who were uninsured in non-expansion states  compared with each of the four groups of low-income adults who were  insured;  low-income adults who were uninsured in expansion states compared  with low-income adults who were uninsured in non-expansion states;  low-income adults who had Medicaid in expansion states compared  with low-income adults who had Medicaid in non-expansion states;  and  low-income adults who had private health insurance in expansion  states compared with low-income adults who had private health  insurance in non-expansion states. Estimates of financial  barriers to needed medical, specialty, and other types of health care and  prescription drugs are based on selected survey questions. Appendix VI: Estimates on Place of Care and Services in Expansion and Non- Expansion States and by Insurance Status

This appendix provides estimates on having a usual place of care and  receiving selected health care services for adults—individuals ages 19 to  64, with family incomes that did not exceed 138 percent of the federal  poverty level (FPL)—from the 2016 National Health Interview Survey  (NHIS), which we obtained from the National Center for Health Statistics  (NCHS). Receiving selected health care services.
Why GAO Did This Study

Under PPACA, states could choose to expand Medicaid coverage to certain uninsured, low-income adults. As of December 2017, 31 states and the District of Columbia chose to expand Medicaid to cover these adults, and 19 states did not.
GAO was asked to provide information about the demographic characteristics of and access to health care services for low-income adults—those with household incomes less than or equal to 138 percent of the federal poverty level—in expansion and non-expansion states. This report describes 2016 national survey estimates of (1) the number and demographic characteristics for low-income adults who were uninsured in expansion and non-expansion states, (2) unmet medical needs for low-income adults in expansion and non-expansion states and by insurance status, (3) barriers to health care for low-income adults in expansion and non-expansion states and by insurance status, and (4) having a usual place of care and receiving selected health care services for low-income adults in expansion and non-expansion states and by insurance status.
GAO obtained 2016 NHIS estimates from the National Center for Health Statistics (NCHS), the federal agency within the Department of Health and Human Services that maintains these survey data.
NHIS is a household interview survey designed to be a nationally representative sample of the civilian, non-institutionalized population residing in the United States. Estimates were calculated for demographic characteristics for uninsured, low-income adults. In addition, estimates were calculated for unmet medical needs, barriers to health care, and having a usual place of care and receiving selected health services for low-income adults in expansion and non-expansion states and by insurance status The estimates were based on responses to selected survey questions. GAO selected these survey questions from the Family and Adult Access to Health Care and Utilization and another section of the 2016 NHIS.
GAO took steps to assess the reliability of the 2016 NHIS estimates, including interviewing NCHS officials and examining the data for logical errors. GAO determined that the data were sufficiently reliable for the purposes of its analyses.
The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate.

What GAO Found

According to the 2016 National Health Interview Survey (NHIS), an estimated 5.6 million uninsured, low-income adults—those ages 19 through 64—had incomes at or below the income threshold for expanded Medicaid eligibility as allowed under the Patient Protection and Affordable Care Act (PPACA). Estimates from this nationally representative survey showed that about 1.9 million of the 5.6 million uninsured, low-income adults lived in states that chose to expand Medicaid under PPACA, while the remaining 3.7 million lived in non-expansion states—those that did not choose to expand Medicaid. In 2016, over half of uninsured, low-income adults were male, over half were employed, and over half had incomes less than 100 percent of the federal poverty level in both expansion and non-expansion states.
The 2016 NHIS estimates showed that low-income adults in expansion states were less likely to report having any unmet medical needs compared with those in non-expansion states, and low-income adults who were insured were less likely to report having unmet medical needs compared with those who were uninsured. Among the low-income adults who were uninsured, those in expansion states were less likely to report having any unmet medical needs compared with those in non-expansion states.
The 2016 NHIS estimates also showed that low-income adults in expansion states were less likely to report financial barriers to needed medical care and other types of health care, such as specialty care, compared with those in non-expansion states, and low-income adults who were insured were less likely to report financial barriers to needed medical care compared with those who were uninsured.
Among low-income adults who were uninsured, those in expansion states were less likely to report financial barriers to needed medical care compared with those in non-expansion states.
Finally, the 2016 NHIS estimates showed that low-income adults in expansion states were more likely to report having a usual place of care to go when sick or needing advice about their health and receiving selected health care services compared with those in non-expansion states. The estimates also showed that low-income adults who were insured were generally more likely to report having a usual place of care and receiving selected health care services compared with those who were uninsured. Among the uninsured, relatively similar percentages of low-income adults in expansion and non-expansion states reported having a usual place of care. Similarly, estimates showed that relatively similar percentages of low-income adults who were uninsured in expansion and non-expansion states reported receiving selected health care services, such as receiving a flu vaccine or a blood pressure check.