Commentary: House Health Bill Would End ACA’s Medicaid Expansion, Leaving Most Enrollees Uninsured

Two new CBPP analyses confirm that the House health bill (the American Health Care Act) would effectively end the Affordable Care Act’s (ACA) expansion of Medicaid and likely cause the overwhelming majority of those currently covered by the expansion to become uninsured. The first analysis shows that states almost certainly could not afford to continue the expansion when faced with the House bill’s cuts in federal funding.[1] It also debunks claims that delaying these cuts or phasing down federal funding more slowly, as the Senate is reportedly considering,[2] would enable states to continue their expansions. The second analysis rebuts claims that those losing their Medicaid expansion coverage would be able to obtain private insurance in the individual market. It finds that many of these poor- and near-poor adults would face premiums exceeding a quarter or half of their income, for coverage inadequate to their needs.[3]

The ACA’s Medicaid Expansion Has Produced Dramatic Coverage Gains

Before the Affordable Care Act, low-income adults without disabilities, including millions of people working in low-wage jobs, often lacked access to affordable health insurance. State Medicaid programs generally covered only the very lowest-income parents, and they mostly didn’t cover low-income adults without children at all. That’s why more than 40 percent of poor, non-elderly adults were uninsured in 2010. The ACA changed that, by giving states enhanced federal funding to expand Medicaid to everyone with income below 138 percent of the federal poverty line (about $16,000 for a single adult).

The benefits have been dramatic. In the 31 states and DC that took up the ACA’s expansion of Medicaid, the uninsured rate among non-elderly adults has been cut in halfsince 2013, the year before the Medicaid expansion took effect. And these gains in coverage are translating into gains in access to care, health, and financial security. One recent study found that the Medicaid expansion increased the share of low-income adults getting check-ups, getting regular care for chronic conditions, and who say they’re in excellent health, and decreased the share relying on the emergency room for care, skipping medications due to cost, and struggling with medical bills.[4]

Medicaid expansion is also benefiting state budgets and helping small and rural hospitals stay afloat. In expansion states, uncompensated care costs have dropped by half as a share of hospital budgets since 2013.[5]

– Center on Budge and Policy Priorities

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