Through the Reconciliation Act, stakeholders and advocates are focusing on the implementation process and what it means at the state level.
A new resource from Manatt Health provides state-specific estimates about Medicaid coverage and hospital spending, as well as congressional area-level data. The authors estimate that nearly 9 million people will lose Medicaid, “which translates into one-tenth of Medicaid currently participating in Medicaid across the country, losing coverage.” They found that over the next decade, the total Medicaid (federal and state funds) will reach $1.2 trillion and hospitals will lose 18% of their Medicaid funds.
Hospitals will lose 18% of their Medicaid funds.
Similarly, a KFF analysis of state-level impacts found that federal Medicaid spending alone would drop $1 trillion in a decade, accounting for 15% of federal Medicaid spending that period. Spending cuts vary by country. Louisiana and Virginia were most affected, with a 21% decrease. More than half of the Medicaid cuts in the bill come from policies targeting ACA's expansion countries, such as work report requirements ($326 billion) and more frequent eligibility re-determination ($63 billion).
Expansion state, rural areas will suffer the biggest blow
The expansion state with a large number of rural residents will be hit the hardest. A separate KFF analysis notes that Medicaid covers one-quarter of adults in rural areas, has a higher share than urban areas, and plays a big role in financing rural health care services. Analyze the project Rural state will lose $155 billion in federal Medicaid fund under the bill, far exceeding the last-minute increase of $50 billion in Rural Health Fund members.
In fact, these reductions are mainly concentrated in 12 states with large rural populations and expanding Medicaid. Kentucky, North Carolina, Virginia, Illinois, New York, Ohio, Pennsylvania, Michigan, Oklahoma, Missouri, Minnesota and Louisiana could lose $5 billion or more.
The rural population of 12 states and the states that expand Medicaid could lose $5 billion or more.
But everyone feels the impact. Many other harmful Medicaid changes apply widely, such as the simplification of Medicaid eligibility and update procedures ($167 billion) and new restrictions on state financing programs ($340 billion). Overall, earthquake transitions are expected to occur throughout the healthcare system, increasing costs and reducing health care across the country.
Advocate for how laws can be implemented
The extent of these challenges will become clearer when the law is implemented. For example, how the state will respond to changes in Medicaid and how much control federal agencies will exercise over state choices.
As states work hard, there will be opportunities to weigh these new requirements and help shape their opportunities to roll out at the federal level.
Because there are still many things to decide, participation and advocacy is still crucial. As states work hard, there will be opportunities to weigh these new requirements and help shape their opportunities to roll out at the federal level. Throughout the process, Medicare rights will remain firmly committed to keeping policy makers accountable, mitigating and reversing the harms of the bill, and advocating policies that enhance health, well-being and dignity.
Further reading
Manatt Health: Impact on state Medicaid coverage and spending, hospital spending, including the impact of the congressional district.
KFF: Allocation CBO Estimates of Reduced Medicaid Spending in States: Senate Settlement Bill.
KFF: How will Medicaid in the Senate pass settlement bill affect rural areas?
