Skip to Main Content

Seven State Options to Reduce the Number of Uninsured (and Stabilize Insurance Markets)

By Stan Dorn,


The Affordable Care Act (ACA) added 20 million people to the ranks of the insured, comprising our country’s largest coverage expansion since the creation of Medicare and Medicaid more than 50 years ago. But millions still remain without coverage, giving states an opportunity to build on the ACA’s progress by pioneering innovative strategies to cover the remaining uninsured, often while stabilizing insurance markets and lowering premiums. In this report, we describe seven state options to achieve these goals, typically building on efforts already under way in vanguard states. We hope this analysis will inform the development of state policy agendas that can move forward in 2019, achieving important gains for consumers while laying the groundwork for bolder national coverage expansions in the future.