This issue brief from the Kaiser Commission on Medicaid and the Uninsured describes how a repeal of the expansion of Medicaid under the Affordable Care Act (ACA) would impact both tens of billions of dollars in state government budgets and millions of Americans who now rely on the expanded Medicaid program for their health insurance coverage.

32 states and the District of Columbia have implemented the expanded Medicaid program, covering all individuals residing in those states with incomes below 138 of the Federal Poverty Level ($16,394/year for an individual and $33,534/year for a family of four in 2016). As of 2015, an estimated 10.7 million Americans were enrolled in these expanded Medicaid programs and are risk of losing their health insurance coverage if the expansion of Medicaid under the ACA is repealed.

Under the ACA, almost all the costs for Medicaid expansion have paid by the federal government (100% for Fiscal Years 2014 through 2016, and phasing down to 95% this Fiscal Year 2017, eventually to 90% in Fiscal Year 2020). States that wanted to maintain some health insurance coverage for some or any of those 11 million Americans would have to use state funds to pay for such coverage. This is a cost shift of tens of billions of dollars from the federal government to state governments. During the first 18 months of the implementation of the Medicaid expansion, states received an estimated $79 billion to cover their costs. All these federal funds would become unavailable to the states with repeal.

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