Failure to expand Medicaid does not simply deny coverage to the most vulnerable individuals—it affects the entire community who feel the impact of treating individuals without insurance coverage.
More than 72 million Americans are enrolled in Medicaid, the health insurance program for low-income Americans funded jointly by states, territories and the federal government and administered by the states. It's one of the largest health plans in the country.
72M
The number of Medicaid enrollees, making up about a fifth of the country's total population.
Federal law dictates certain parameters that all states must follow, but each state administers its Medicaid program differently, resulting in coverage variations.
Beginning in 2014, the Patient Protection and Affordable Care Act provided states with the authority to expand Medicaid eligibility to include individuals, mainly working adults without children whose incomes do not exceed 138% of the federal poverty level. As of 2025, states expanding coverage to this population are eligible for an enhanced federal medical assistance percentage of 90%—significantly higher than the FMAP for services offered to the "traditional," non-expansion Medicaid population, including children, the disabled, elderly people and pregnant people.
In 2021, the American Rescue Plan created a new incentive for states that had not yet expanded Medicaid. Those that expanded Medicaid after March 2021 received a two-year, 5-percentage-point increase in the federal matching rate for their non-expansion enrollees.
The AAFP supported these policies and continues to advocate for robust Medicaid funding and coverage.
“If we truly want to improve our nation’s health to optimize longevity, it must start with investing in Medicaid and other safety-net supports—not cutting them.”
The Robert Graham Center found that states that haven't expanded Medicaid forego the opportunity to expand their primary care workforces by a total of 1,525 physicians. Increased demand from expansion states and a limited primary care physician pool may provide a pull across state lines to the disadvantage of non-expansion states. This evidence also suggests that primary care physicians generate up to $1.5 million in annual revenues and 23 new jobs per physician.
The AAFP's advocacy for Medicaid expansion
Medicaid is a lifeline for low-income individuals and families, children, pregnant people, elderly adults and individuals with disabilities. It provides coverage for essential medical care, preventive services and long-term services and supports that many would be unable to afford otherwise.
Family physicians are at the forefront of health care delivery and witness firsthand the positive impact that Medicaid has on their patients’ lives. Advocating for strengthened Medicaid coverage aligns with the Academy's principles of seeking to ensure health care coverage for all by increasing access to care and enabling family physicians to provide cost-efficient care.
