Even as the repeal of Obamacare looms, it is likely to be politically challenging for states to completely jettison a centerpiece of the Affordable Care Act (ACA) that has extended health insurance to millions across the country, says UMass Medical School’s Robert W. Seifert, MPA.
With the passage of the ACA in 2010, the federal government granted states billions of dollars to add millions of people to the rolls of local Medicaid programs that provide health insurance to the low-income and disabled.
However, while the American Health Care Act (AHCA) passed by the House of Representatives on May 4 aims to phase out federal support for Medicaid expansion, states will likely tread carefully when it comes to yanking health benefits from millions of voters, believes Seifert, principal of the Center for Health Law and Economics at UMass Medical School.
“At the state level, once you have instituted a change like this, which has delivered insurance coverage to 10 or 11 million people who didn’t have it before, it is hard to take that away,” Seifert says.
The 31 states and the District of Columbia who expanded their Medicaid programs since the ACA was passed in 2010 face the biggest challenges, he believes.
States that have expanded Medicaid took in an additional $73 million in federal funding in 2016 alone, the Robert Wood Johnson Foundation has found.
However, the AHCA would effectively stop paying for further Medicaid expansion starting in 2020, though federal subsidies would still flow for new members signed up before then.
Even so, governors and state lawmakers will face pressure to continue paying for expanded Medicaid benefits even after the federal money stops flowing, according to Seifert.
“Governors and state legislatures who are much more answerable to their local constituencies than the Congress or the president are, I think, would be hard pressed to revoke that expansion and coverage,” Seifert says.
Even though the Medicaid program consumes a large part of a state’s budget, Seifert says, “I just can’t see states just wholesale taking away coverage from people once they have extended it.”