A new state-by-state analysis by the Kaiser Family Foundation examines federal
Medicaid spending changes under the Better Care Reconciliation Act (BCRA),
which would phase out enhanced Medicaid expansion funding and use an annual per
enrollee cap on federal funds for most Medicaid enrollees in all states. The
analysis finds federal spending would decline by $519.4 billion between 2020
and 2029, including reductions of $119.8 billion in California, $19.9 billion
in Illinois, $11 billion in Indiana, $4.3 billion in Nevada, $3.4 billion in
West Virginia and $1.2 billion in Maine. The figures in the analysis,
which assumes Medicaid expansion states keep their expansions, highlight how
much of their own money states would need to spend to keep their Medicaid
programs going at current levels in the face of the federal cuts. Of the $519.4
billion in federal Medicaid spending reductions, about $302 billion would be
attributable to the phase-out of Medicaid expansion funding and $218 billion to
the per enrollee caps.
A second analysis finds
that repealing the Affordable Care Act’s Medicaid expansion with no replacement
plan – a straight repeal that would eliminate the statutory authority to cover
childless adults as well as the enhanced federal funds to support the expansion
– would result in reductions of federal Medicaid funding of $700.3 billion from
2020 to 2026 compared to what Medicaid expansion states would have received
under current law. In 2026, the reduction to states would be $120.6 billion,
and 17.6 million fewer people would have Medicaid coverage that year. Spending
reductions per state range from $180.4 billion over the period in California to
$1.4 billion in North Dakota, and include reductions of $25.9 billion in
Kentucky, $8.6 billion in Nevada and $6.4 billion in West Virginia.
Filling the need for trusted information on
national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo
Park, California.
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