If Donald Trump returns to the White House, and a Republican Congress succeeds in 2025, for instance, major changes may affect Medicaid funding. These kinds of cuts could be calamity scenarios for millions of Americans-fearing that nine states might rescind their Medicaid coverage if federal funds are cut. Below is an examination of what such cuts might look and feel like, and which states will bear the risk.
The medicaid expansion landscape
The Affordable Care Act, passed in 2010, incentivized states to expand their Medicaid programs to cover low-income residents who don’t get insurance through work. About 21 million people have picked up coverage through Medicaid expansion since 2014, helping drive the uninsured rate to historic lows in the United States. To date, 40 states and D.C. have opted into that expansion, which expanded eligibility for adults to 138% of the federal poverty level.
But politics are shifting. With the Trump administration certain to propose cuts to federal Medicaid funding, many states that expanded their programs – which includes most of them – are in a state of limbo about what future coverage will look like.
States at risk of coverage cuts
According to recent analyses by health policy organizations such as KFF and the Georgetown University Center for Children and Families, nine states are particularly vulnerable if federal funding is reduced:
- Arizona
- Arkansas
- New Mexico
- Indiana
- Montana
- Idaho
- North Carolina
- Utah
- Iowa
These states have implemented “trigger laws” that would automatically terminate their Medicaid expansions if federal funding drops below a certain threshold. In all, more than 3 million adults in these states could lose health coverage almost immediately if such cuts occur.
Implications of funding cuts
Potential cuts to Medicaid funding could have disastrous consequences, affecting not only the recipients but also health systems and state budgets. Experts say that states may have no choice but to drastically slash eligibility, benefits, or provider reimbursement rates without federal support. This could result in tens of millions of Americans becoming uninsured or underinsured, significantly impacting access to healthcare services.
For example, Arizona’s trigger law would drop its Medicaid expansion if federal funding falls below 80%; Montana’s law offers a rollback if funding goes below 90%, though it does provide some flexibility for state lawmakers to identify other funding sources. These conditions create a tightrope for state governments in balancing budgets while seeking to maintain key health services.
Political dynamics and future prospects
The political dynamics of Medicaid reform are intricate. Traditionally, Republican leadership has attempted to slash federal funding for social programs, including Medicaid, while actual reductions are typically far lower in reality and usually reflect state-specific politics. As discussed earlier, six out of nine states imposing trigger laws voted for Trump during the 2024 elections. But the degree to which Medicaid expansions are preserved or rolled back will, again, be a matter of local politics and popular will.
Experts say that while states rarely revoke eligibility once granted, trigger laws make it easier on lawmakers because such laws allow automatic cuts to be made without additional action by legislatures. That could mean quick changes in coverage if federal support is reduced.
The larger consequence on access to care
Potential Medicaid cuts have far-reaching implications for the American healthcare landscape beyond what would be felt within an individual state. A reduction in Medicaid enrollment would likely worsen existing disparities in access to and outcomes of care, particularly for vulnerable populations of low-income families, seniors, and people with disabilities.
The sudden rise of the uninsured into the provider system will require adaptation for health care providers as well-the people who show up could be sicker because they’ve postponed care, leading to yet another increase in both emergency room use and overall costs.
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