Potential Medicaid Expansion Rollback Could Increase Mortality, Analysis Finds

Republican lawmakers are considering reducing the federal government's 90 percent match rate for Medicaid expansion under the Affordable Care Act.

This proposal is part of a broader reconciliation plan aimed at offsetting costs related to extending tax cuts. An analysis by the Centers for American Progress estimates that such a rollback could lead to approximately 34,200 additional deaths annually if states respond by terminating or modifying their Medicaid expansion programs, particularly in the 12 states with existing 'trigger' laws linked to changes in federal funding.

The analysis draws on a 2017 study by health economist Benjamin Sommers, which found that for every 239 to 316 adults gaining insurance through Medicaid expansion, one life is saved each year. Currently, the federal government funds 90 percent of the costs associated with Medicaid expansion populations.

Republican leaders argue that the current expansion extends coverage beyond the most needy populations and that reducing federal subsidies would preserve the program's integrity. However, cutting the enhanced match would shift significant costs to states, potentially prompting cutbacks in coverage or eligibility.

Some moderate Republicans have expressed concerns about these potential Medicaid cuts, signaling internal debate within the party ahead of planned legislative markups in early May. The outcome of these discussions will have considerable implications for state Medicaid programs, federal budgets, and public health outcomes.