Map Shows States Most Impacted by Republicans’ Plan for Medicaid Benefits

As House Republicans look to push through major changes to Medicaid funding, several states could see health care access on the chopping block, as a Newsweek map shows.

The GOP proposal would impose per capita caps on Medicaid. That structure would limit how much the federal government contributes per enrollee, requiring states to cover any costs above that amount.

However, based on health care analysis by KFF, an independent source for health policy research, not all states would be equally affected by the budget changes, and some states would see a higher cost than others.

Why It Matters

Medicaid currently covers more than 79 million low-income Americans, including many in states that expanded coverage under the Affordable Care Act.

The proposed Republican policy would shift how those services are funded and who remains eligible. With the caps in place, states could be forced to reduce coverage or increase their own spending to maintain current enrollment levels.

What To Know

Before former President Barack Obama signed the Affordable Care Act (ACA) in 2010, Medicaid insurance was typically only available to children, their caregivers, disabled people and pregnant women.

Through the expansion program, states could opt to extend coverage to adults with incomes up to 138 percent of the federal poverty level.

Those states with a higher expansion enrollment and spending would be the most financially impacted by the GOP policy, and past Medicaid beneficiaries could suffer from lack of health care access, experts say.

Under the proposed per capita cap on the Medicaid expansion population, KFF estimates $246 billion would be needed from states to maintain the same level of coverage over the next 10 years.

All expansion states would be impacted, but the increase in state spending would depend on each specific state, ranging from 4 percent in Massachusetts and South Dakota to 20 percent in Louisiana.

By far the states with the highest percent increase of state spending under the per capita cap would be Louisiana (20 percent) as well as Kentucky and Montana, which would both see costs rise by 18 percent.

However, if under the new caps all states decided to drop their Medicaid expansion coverage, up to 20 million Medicaid expansion enrollees could lose Medicaid coverage entirely, KFF found.

Republicans have proposed the per capita cap to help cut at least $2 trillion in spending to offset tax breaks and other priorities. Medicaid, which costs the government over $800 billion annually, has emerged as a prime target.

Today, 41 states and Washington, D.C. have expanded Medicaid under the Affordable Care Act. That helped an additional 21 million Americans gain health insurance.

What People Are Saying

Kevin Thompson, the CEO of 9i Capital Group and the host of the 9 innings podcast, told Newsweek: “The states that would be the most heavily impacted are the ones that voted yes for Medicaid expansion and have some of the largest populations. Think about states including California, New York, and Washington that are big blue states that will feel the brunt of many of these programs. The increased spending will be placed at the foot of the states with less coming from the federal government.”

Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com, told Newsweek: “The expansion states will face an impossible choice: abandon millions of their most vulnerable residents or bankrupt their treasuries. And those 12 states with trigger laws? One federal funding cut and poof!, automatic termination of coverage.”

“The political fallout will be fascinating, though. When voters in places including Missouri and South Dakota approved expansion through ballot measures, they never imagined their coverage could vanish through budget technicalities rather than repeal votes. People don’t forget who took away their health care, especially when there’s nowhere else to turn.”

Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek: “States including West Virginia, Nevada, and others could see spending at the state level increase by billions to make up the gap. And while shifting the financial burden onto the states may help to manage the federal budget, it leaves states with questions on how they can maintain their programs without having to either limit benefits or increase revenues through taxes and other means. In the end, someone has to pay for such a significant shift, and the effects could ultimately encompass more than just those who qualify for Medicaid.”

What Happens Next

House Republicans will be finalizing the legislative package in the coming weeks, but there are still debates going on within the GOP.

Thompson said for the states that voted to expand Medicaid, the per capita caps could hit hard.

“The federal government is expected to dial back the enhanced 90 percent match rate, shifting more of the financial burden onto states,” Thompson said. “In California alone, that could mean an additional $43 billion over the next decade.

States could be forced to scale back programs, cap benefits, or reduce per-person funding while leaving recipients with less than they were promised, but there could also be consequences for the politicians in office.

“Politically, this has the potential to blow up on lawmakers who once lauded the expansion. The ultimate consequence will be felt in the voting booth as to how all of this turns out,” Thompson said.