With Donald Trump's return to the White House and Republicans taking full control of Congress in 2025, the Affordable Care Act's Medicaid expansion is back on the chopping block.
KFF Health NewsDec 4 2024 With Donald Trump's return to the White House and Republicans taking full control of Congress in 2025, the Affordable Care Act's Medicaid expansion is back on the chopping block.
In exchange, the federal government pays 90% of the cost to cover the expanded population. That's far higher than the federal match for other Medicaid beneficiaries, which averages about 57% nationwide. For instance, Michigan approved a trigger as part of its Medicaid expansion in 2013, when it was controlled by a Republican governor and legislature. Last year, with the government controlled by Democrats, the state eliminated its funding trigger.
Across the states with triggers, between 3.1 million and 3.7 million people would swiftly lose their coverage, researchers at KFF and the Georgetown center estimate. The difference depends on how states treat people who were added to Medicaid before the ACA expansion; they may continue to qualify even if the expansion ends.
"With a reduction in the expansion match rate, it is likely that all states would need to evaluate whether to continue expansion coverage because it would require a significant increase in state spending," said Robin Rudowitz, vice president and director of the Program on Medicaid and the Uninsured at KFF.
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