Many Low-Income Parents Could Lose Medicaid in ACA Repeal, Analysis Finds

It’s hard to say exactly what a repeal and replacement of the Affordable Care Act (ACA) would look like under the incoming Trump Administration, but so far, the groups that stand to lose are those who have gained coverage in large numbers since 2014: low-income parents and adults who worked in jobs without health coverage.

Medicaid expansion, which has reached 32 states, allowed an estimated 11 million adults to become insured as of 2015, according to an analysis by the Kaiser Commission on Medicaid and the Uninsured, a project of the Kaiser Family Foundation.

As there is no specific plan from the president-elect on what will happen to those who benefited from Medicaid expansion, it is impossible to say whether some or all these adults will lose coverage; however, the Commission’s report said this number has grown with recent expansions in Louisiana and Montana.

“While it is difficult to quantify the specific effects of a repeal of the ACA Medicaid expansion given the many uncertainties that remain at this time, examining the changes in coverage and financing that have occurred under the Medicaid expansion provide insight into the scope of coverage and the funding that may be at risk under a repeal,” the report states.

The report includes a table that outlines the difference in what it took for parents in a family of 3 to qualify for Medicaid before 2013, and what it takes for that same family to qualify today, since most states extend Medicaid up to 138% of the federal poverty level (FPL). In Oregon, in 2013, a family of 3 received Medicaid up to 39% of the FPL, which was $19,530. Today, a family of 3 in Oregon earning up to 138% of the FPL—which has been raised to $20,160—can receive Medicaid.

In 24 states, adults without children had no opportunity to qualify for Medicaid before the ACA. It is unclear what would happen to those adults even if they are working at jobs that offer no health coverage.

The Commission’s report, by Robin Rudowitz, Samantha Artiga, and Katherine Young, outlines the progress made by consumers who benefited from Medicaid expansion, and what ground could be lost if these gains are wiped out completely:

· The uninsured rate among the nonelderly fell from 16.6% in 2013 to 10% in 2016; it had already dropped due to a change that allowed adult children to remain on parents’ plans up to age 26.

· Before expansion, most states limited Medicaid for nondisabled adults. This could mean a return to cases in which children of the working poor have coverage, but not their parents.

· Loss of coverage would be greatest in Medicaid expansion states, including 16 that will have Republican governors in 2017. Medicaid enrollment growth was 3 times greater in expansion states (36% vs 12%).

· An estimated 11 million Medicaid enrollees may risk losing coverage if states can longer extend eligibility to low-income adults up to 138% of the FPL, and if enhanced federal financing is withdrawn.

· Economic gains made by states that expanded Medicaid would cease, including budget savings and job creation. Increased revenues to hospitals, including those that are safety nets in their communities, would be discontinued, and it is not clear how these dollars would be replaced.