Repealing the ACA’s Medicaid Expansion: What’s at Risk

In this new Kaiser Family Foundation report on the consequences for Medicaid expansion if the Affordable Care Act (ACA) is repealed, two numbers particularly stand out:

  1. 11 million adults have gained Medicaid coverage in 31 states and DC because of the Medicaid expansion under the Affordable Care Act.
  1. Through mid 2015, Medicaid expansion states have received $79 billion in new federal Medicaid funding – and are getting more every day.

These are huge numbers and reflect the very real gains the Affordable Care Act has made possible, especially in states that have accepted the federal Medicaid funding. And, as Kaiser points out, these expansion states are split almost exactly between Democratic and Republican Governors, further exacerbating the political minefield of repealing the funding and coverage now available:


The final point the Kaiser report makes is perhaps the most understated but has the potential to be the most important. The economic impact on states – something that Governors and state legislatures care about very much, regardless of party – is significant:

“Broader economic gains states have realized as a result of the Medicaid expansion could be affected [by repeal]. National, multi-state, and single-state studies show that states expanding Medicaid under the ACA have realized budget savings, revenue gains, and overall economic growth despite Medicaid enrollment growth initially exceeding projections in many states. Studies show that states have achieved net positive economic impacts from increased employment; increased revenues to hospitals, physicians, and other providers; decreases in uncompensated care; and savings in other state programs, such as state-funded behavioral health or corrections.”

Looking at the numbers of people affected, the economic impact, and the bipartisan makeup of expansion states presents a sobering picture of the consequences of repeal of the ACA, including Medicaid expansion without a plan for replacement.