Pro-Medicaid protesters on Capitol Hill. Photo: Bill Clark/CQ Roll Call via Getty Images

The Affordable Care Act’s insurance exchanges have been the law's headline feature over the past eight years, but the law’s Medicaid expansion has covered just as many people, and its rolls are more likely to grow under the Trump administration.

Driving the news: Roughly 8.8% of Americans were uninsured last year, according to new Census figures released yesterday — essentially unchanged from 2016. That means the Trump administration has not kept the ACA’s coverage gains going, nor has it successfully rolled them back — at least, not yet.

However you slice it, states that expanded Medicaid cover more people, with more stability.

  • The uninsured rate rose last year in non-expansion states, even as it held steady nationally.
  • It’s no big surprise that more low-income families would have insurance in expansion states than non-expansion states. But expansion states cover more people across the board, including people whose incomes would make them ineligible for Medicaid.

What’s next: The Trump administration has mostly muddied the waters for the ACA's exchanges, rather than blown them up. Its biggest threat to the Medicaid expansion is its willingness to approve work requirements for the program.

  • Those new rules are just getting started, and the impacts can be significant: Arkansas has booted more than 4,000 people off the program in just one month.

Yes, but: More states are also likely to opt into the expansion this year or next, and work requirements are facing a challenge in the courts.

  • The same judge who previously blocked Kentucky’s work requirements from taking effect will also decide the fate of Arkansas’ policy. Judge James Boasberg said yesterday that the two are related and he’ll keep them both.

Go deeper

Updated 5 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 10 p.m. EST: 32,135,220 — Total deaths: 981,660 — Total recoveries: 22,149,441Map.
  2. U.S.: Total confirmed cases as of 10 p.m EST: 6,975,980 — Total deaths: 202,738 — Total recoveries: 2,710,183 — Total tests: 98,481,026Map.
  3. Politics: House Democrats prepare new $2.4 trillion coronavirus relief package.
  4. Health: Cases are surging again in 22 states — New York will conduct its own review of coronavirus vaccine.
  5. Business: America is closing out its strongest quarter of economic growth.
  6. Technology: 2020 tech solutions may be sapping our resolve to beat the pandemic.
  7. Sports: Pac-12 will play this fall despite ongoing pandemic — Here's what college basketball will look like this season.
  8. Science: Global coronavirus vaccine initiative launches without U.S. or China — During COVID-19 shutdown, a common sparrow changed its song.
8 hours ago - Sports

Pac-12 will play football this fall, reversing course

A view of Levi's Stadium during the 2019 Pac-12 Championship football game. Photo: Alika Jenner/Getty Images

The Pac-12, which includes universities in Arizona, California, Colorado, Oregon, Utah and Washington state, will play football starting Nov. 6, reversing its earlier decision to postpone the season because of the coronavirus pandemic.

Why it matters: The conference's about-face follows a similar move by the Big Ten last week and comes as President Trump has publicly pressured sports to resume despite the ongoing pandemic. The Pac-12 will play a seven-game conference football season, according to ESPN.

Dave Lawler, author of World
9 hours ago - World

Global coronavirus vaccine initiative launches without U.S. or China

Data: Gavi, The Vaccine Alliance; Map: Naema Ahmed/Axios

A global initiative to ensure equitable distribution of coronavirus vaccines now includes most of the world — but not the U.S., China or Russia.

Why it matters: Assuming one or more vaccines ultimately gain approval, there will be a period of months or even years in which supply lags far behind global demand. The COVAX initiative is an attempt to ensure doses go where they're most needed, rather than simply to countries that can produce or buy them at scale.

Get Axios AM in your inbox

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Subscription failed
Thank you for subscribing!