Medicaid Expansion Rollback Could Increase Mortality, Analysis Finds

A recent analysis by the Center for American Progress (CAP) highlights the potential health impacts of a proposed rollback in the federal government's Medicaid expansion funding. Currently, the federal government covers 90% of the costs for Medicaid expansion under the Affordable Care Act (ACA). Republican lawmakers are considering reducing this match rate as part of budget reconciliation efforts to offset the cost of extending certain tax cuts. If the federal match rate decreases, some states with legal 'trigger' provisions may opt to end their Medicaid expansions.

The CAP analysis estimates that around 34,200 additional deaths could occur annually if the federal match is rolled back and states consequently terminate their expansion programs. This estimation is based on a 2017 Harvard study, which found that Medicaid expansion saves one life per approximately 239 to 316 newly insured adults. Since 12 states have trigger laws tied to the federal match rate, the rollback could affect coverage in these areas.

Legislatively, the Medicaid funding reconsideration falls under the jurisdiction of the House Energy and Commerce Committee, which plans a markup session in early May 2025. Republican policymakers argue that reducing the federal match will encourage states to focus Medicaid services on the most vulnerable populations, rather than the broader groups covered under ACA expansions. However, this strategy would shift significant costs from the federal government to states, potentially forcing difficult budgetary choices at the state level.

The debate includes differing views within the Republican party, with some opposing cuts to Medicaid benefits. Twelve moderate Republican representatives have already expressed concerns about cuts leading to reductions in Medicaid coverage, though their stance on the federal match rollback remains unclear. Statements from Republican leaders emphasize preserving Medicaid for high-need populations such as individuals with disabilities and the elderly.

This policy discussion reflects ongoing tensions between federal budget priorities and state health coverage mandates. The decision on Medicaid funding will influence both federal and state budgets, Medicaid enrollment, and broader public health outcomes. Insurance professionals should monitor these developments closely due to potential impacts on Medicaid program integrity, enrollment levels, and state-federal funding relations.