9 states could halt Medicaid expansion if Trump cuts funding

(NewsNation) — Over 3 million Americans could lose health coverage under the Affordable Care Act’s Medicaid expansion if President-elect Donald Trump pulls funding that would trigger automatic eliminations in several states. 

Cutting federal spending is one of Trump's many goals for his second term in the White House, and although he did not explicitly outline his plans for Medicaid, some suspect he may try to slash funding. 

Medicaid provides nearly free health care coverage to millions of the poorest children and adults in the U.S., while Medicare gives older Americans and the disabled access to health insurance. The Affordable Care Act is the Obama-era program that offers health insurance plans to millions of Americans who do not qualify for government-assisted health insurance but do not get insurance through their employer.

The Trump administration could choose not to implement recent regulations on Medicaid, which include expanding it to millions of low-income people who didn’t get health insurance through their jobs. 

In the event this occurs, at least nine states would almost immediately lose insurance, according to The KFF, formerly the Kaiser Family Foundation, a nonprofit organization that researches health care issues,  and the Georgetown University Center for Children and Families. 

The Affordable Care Act encouraged states to expand Medicaid programs to cover more people, prompting forty states to extend health insurance, the group stated. The federal government agreed to pay 90% of the cost to cover the expanded population in return.

But several states have automatic trigger laws where if federal funding dropped below this threshold, so would Medicaid expansions, the groups reported. 

These states are Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia, according to KFF. 

Most of the nine states’ triggers kick in if federal funding falls below the 90% threshold, but in Arizona, the trigger is below 80%.

Researchers estimated that across the states with triggers, between 3.1 million and 3.7 million people would swiftly lose their coverage.

If Congress cuts federal funding, Medicaid expansion would be at risk in all states that have opted into it, including those without trigger laws, because state legislatures would be forced to make up the difference, Renuka Tipirneni, an associate professor at the University of Michigan’s School of Public Health, told the group. 

Decisions to keep or roll back the expansion “would depend on the politics at the state level,” Tipirneni said.

Six of the nine states with trigger laws voted for Trump in the 2024 election, reported KFF.

In his first term, Trump attempted to repeal the Affordable Care Act, which was enacted under the Obama Administration and expanded Medicaid and health care access to previously uninsured people.

Trump has switched gears and said he will keep ACA, also known as Obamacare, but will make changes. He has been even less specific on his plans for Medicaid. 

He chose Mehmet Oz, a celebrity heart surgeon turned talk show host and lifestyle guru, as his pick to run the Centers for Medicare and Medicaid Services.