title: How Will Repealing the ACA Affect Medicaid? Impact on Health Care Coverage, Delivery, and Payment.
abstract: ISSUE: The Affordable Care Act enhanced Medicaid's role as a health care purchaser by expanding eligibility and broadening the range of tools and strategies available to states. All states have embraced delivery and payment reform as basic elements of their programs. GOAL: To examine the effects of reducing the size and scope of Medicaid under legislation to repeal the ACA. FINDINGS AND CONCLUSIONS: Were the ACA's Medicaid expansion to be eliminated and were federal Medicaid funding to experience major reductions through block grants or per capita caps, the effects on system transformation would be significant. Over 70 percent of Medicaid spending is driven by enrollment in a program that covers 74 million people; on a per capita basis Medicaid costs less than Medicare or commercial insurance. States would need to absorb major financial losses by reducing the number of people served, reducing the scope of services covered, introducing higher cost-sharing, or further reducing already low payments. Far from improving quality and efficiency, these changes would cause the number of uninsured to rise while depriving health care providers and health plans of the resources needed to care for patients and invest in the tools that are essential to system transformation
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, USA. sarar@gwu.edu
authors.forename: Sara
authors.initials: S
authors.lastname: Rosenbaum
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Rothenberg
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Schmucker
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gunsalus
authors.affiliation: George Washington University, USA.
authors.forename: J. Zoë
authors.lastname: Beckerman
mesh_terms: D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics* / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000706:statistics & numerical data*; D013219:State Government; D014481:United States