As many as 20 million Americans could lose Medicaid coverage over the course of 10 years thanks to Republican proposals to cut the Affordable Care Act’s Medicaid expansion match rate, according to a recent analysis.
The most affected states in that estimate include Oregon, Virginia, Louisiana, and Nevada, a report from policy group KFF said. Louisiana and Nevada both voted for President Donald Trump. While other “red states” such as Michigan, Indiana, Kentucky, West Virginia and Montana were also all projected to see at least a 30 percent drop in the number of people covered in the state.
But, it’s not just Republican-leaning states impacted as California, Oregon, Washington, Virginia and New Mexico were all projected to see at least 30 percent drops as well.
The findings come as Republicans have worked to defend their efforts to shrink the Affordable Care Act, aiming to provide billions of dollars for tax cuts and border security. President Donald Trump had previously said he would not touch Medicaid, but has endorsed the House Republican budget that targets the program.
More than 72 million Americans were enrolled in Medicaid last fall. The program, which turns 60 this summer, helps to cover costs for people with limited income and resources, offering nursing home care and other services.
A Politico review of enrollment in Medicaid by congressional district published on Monday found that 11 GOP members in competitive seats represent larger-than-average Medicaid populations. Voting to strip care could come back to haunt them in the 2026 midterm elections.
“We are not interested in cutting the social and health care safety net for children, disabled, and low-income Americans,” Ken Calvert, a California Republican, told the outlet. “We are focused on eliminating waste, fraud, and abuse, as well as strengthening work requirements for able-bodied working age adults with no children.“
However, others, such as Texas Rep. Tony Gonzales, are breaking with Trump and House Speaker Mike Johnson on the issue.
“There’s no doubt that there’s waste, fraud and abuse in every program in the government, including Medicaid – but at what point do you stop cutting into the fat and start cutting into the bone? You can’t pull the rug out from millions of people,” he told Politico in a separate piece.
Rep. Tony Gonzales is one of many Republicans speaking out about the proposed cuts to Medicaid. One Idaho state representative said she had received hundreds of emails begging for it not be repealed (Getty Images)
“Quite honestly, I have received hundreds of emails from constituents that have said, ‘please do not repeal.’ I have received zero asking me to repeal, which I think is very telling,” Idaho state Rep. Lori McCann told Stateline.
Even former Trump White House chief strategist Steve Bannon said Republicans can’t just “take a meat axe to” Medicaid.
“Medicaid, you gotta be careful,” he said on his podcast last week. “Because a lot of MAGAs are on Medicaid, I’m telling you. If you don’t think so, you are dead wrong.”
The Affordable Care Act allows states to expand Medicaid coverage to adults with incomes up to 138 percent of the poverty level, and states that have adopted the expansion have lowered their uninsured rates. More than 40 states have adopted the expansion.
The current Medicaid expansion match rate is 90 percent, meaning the federal government pays 90 percent of the costs for enrollees for those who qualify. It currently covers over 20 million people, KFF says. But that program could be targeted under Trump and the Republicans.
Republicans such as Steve Bannon have pushed back on plans to slash Medicaid because of who it would impact – Republican voters. The program helps to cover nursing home costs and other services (Getty Images)
U.S. healthcare spending reached $4.9 trillion in 2023 and accounted for 17.6 percent of the Gross Domestic Product. Of that $872 billion was for Medicaid – although Medicaid spending and enrollment growth has slowed. There was a record-high level of enrollment that year. Enrollment was projected to decline over the course of 2024 and 2025 following the unwinding of a policy that kept people enrolled throughout the pandemic.
To reduce Medicaid spending, lawmakers are considering eliminating the expansion match rate. If they drop the expansion coverage in response to the elimination for the 90 percent federal match rate, there would be a 25 percent decrease in federal Medicaid spending, KFF said. But, 20 million would lose coverage, in one scenario presented by the non-profit.
“This is also only one of the various Medicaid policy changes that have been suggested and estimates would change if multiple policies were considered together,” it said.
Nevada, which went red last presidential election, is one of the states with the highest estimated percent decline in Medicaid enrollment by Fiscal Year 2034 if current expansion states dropped the expansion. Elimiating the rate could reduce total enrollment by between 19 and 49 percent (Getty Images)
Should the current expansion states drop the expansion, the report said eliminating the match rate could reduce total enrollment by 19 percent across the 40 states with expanded coverage.
In Virginia, there would be an estimated 45 percent decline in enrollment by Fiscal Year 2034 if current expansion states dropped the expansion. There would also be a 41 percent decline in Louisiana and a 42 percent decline in Nevada.
Cutting Medicaid services could lead states to slash other areas, Nevada Democrats told The Daily Indy.
“Cutting those services would be extremely detrimental,” Nevada Democrat Nicole Cannizzaro said. “Should that happen outside of a legislative session, [that would put this body] into a place where we would have to come back into this building to cut significantly budgets that we have, because that federal funding is incredibly important to how it is that we are providing those services.”
