The 17 highest-union-density states have all adopted the Affordable Care Act’s Medicaid expansion: Number of high-, medium-, and low-union-density states that had adopted the Medicaid expansion as of 2024
| Expanded Medicaid | Did not expand Medicaid | |
|---|---|---|
| Low | 10 | 7 |
| Medium | 14 | 3 |
| High | 17 | 0 |
Notes: Union density is defined as the share of workers in the state who are represented by a union, including union members and other workers who are covered by a union contract, based on the variable “union” from EPI extracts of CPS-ORG microdata.
Notes: Union density is defined as the share of workers in the state who are represented by a union, including union members and other workers who are covered by a union contract, based on the variable “union” from EPI extracts of CPS-ORG microdata. Low-union-density states are the 17 states with the lowest average union densities from 2022–2024 (with union densities ranging from 3% to 8%). Medium-union-density states are the 17 states (including D.C.) in the middle of the union-density rankings (with union densities ranging from 8.2% to 13.1%). High-union-density states are the 17 states with the highest average union densities from 2022–2024 (greater than 13.4%).
Sources: EPI analysis of 2022–2024 Current Population Survey Outgoing Rotation Group (CPS-ORG) microdata for all workers ages 16 and older; KFF, “Status of State Medicaid Expansion Decisions,” May 9, 2025.