Grand Canyon Times

With Donald Trump returning to the White House and Republicans gaining full control of Congress in 2025, the Affordable Care Act's Medicaid expansion faces potential cuts. According to KFF, a health information nonprofit, and the Georgetown University Center for Children and Families, over 3 million adults in nine states risk losing their health coverage if GOP lawmakers reduce federal Medicaid funding.

The states with trigger laws that would end their Medicaid expansions if federal funding decreases are Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia. The 2010 Affordable Care Act encouraged states to expand Medicaid programs to cover more low-income Americans without employer-provided insurance. Forty states and the District of Columbia expanded coverage since 2014 to approximately 21 million people.

In exchange for expanding coverage, the federal government covers 90% of costs for the expanded population. This is significantly higher than the average federal match of about 57% for other Medicaid beneficiaries nationwide. Conservative policy groups argue that the program is too costly and covers too many people. Democrats maintain that Medicaid expansion has saved lives by providing coverage to those unable to afford private insurance.

Renuka Tipirneni from the University of Michigan’s School of Public Health stated that if Congress reduces federal funding, all states with expanded Medicaid could be affected as state legislatures would need to compensate for reduced funds. "Decisions to keep or roll back the expansion 'would depend on the politics at the state level,'" Tipirneni said.

Michigan eliminated its funding trigger last year under Democratic control after initially approving it when Republicans controlled its government in 2013. Six out of nine states with trigger laws supported Trump in the 2024 election.

Most triggers activate if federal funding drops below a certain threshold: generally below 90%, except Arizona's which activates below 80%. Montana requires legislative reauthorization for its expansion by 2025 or it will end.

Researchers estimate between 3.1 million and 3.7 million people could lose coverage across these states if triggers activate. Three additional states — Iowa, Idaho, and New Mexico — have laws requiring governments to mitigate financial impacts but do not automatically end expansions.

The ACA allowed expansions for adults earning up to 138% of the federal poverty level (approximately $20,783 per individual in 2024). Nearly a quarter of national Medicaid enrollees benefit from these expansions.

Robin Rudowitz from KFF noted that reducing expansion match rates would force all participating states to reassess continuation due to increased state spending requirements: "If states drop coverage... there would be an increase in uninsured numbers."

Edwin Park from Georgetown highlighted how triggers make it politically easier for lawmakers as they require no new action once activated.

The future actions regarding Medicaid by Trump and congressional Republicans remain uncertain; however recent recommendations from Paragon Health Institute suggest phasing down federal matches starting in 2026 until reaching parity with traditional enrollee matches by 2034.

Daniel Derksen from University of Arizona commented on Arizona's situation: “It would be a tough sell right now as it would put a big strain on the budget.”

Republicans previously targeted Medicaid during efforts like repealing Obamacare in 2017 but failed due partly due shifting billions onto state budgets.

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