The recent budget law signed by President Donald Trump will have significant consequences for healthcare in the US, particularly in states that refused to expand Medicaid under the Affordable Care Act (ACA). The law imposes new rules for verifying eligibility for subsidized coverage, shortens enrollment periods, and cuts funding for navigators who help people shop for plans. These changes are expected to cause a projected 870,000 Floridians to lose health insurance by 2034.
In states that did not expand Medicaid, such as Florida, Georgia, and Mississippi, the impact will be even more severe. A higher proportion of residents in these states are enrolled in ACA plans, and the changes to the law will erode enrollment and increase the number of uninsured people. For example, Georgia will see as many people lose insurance coverage as California, despite having a population that is less than one-third the size.
The law also trims federal spending on Medicaid by more than $1 trillion over the next decade, which will lead to 10 million people losing coverage over the next decade. The nonpartisan Congressional Budget Office estimates that allowing enhanced subsidies to expire will increase the number of people without health insurance by 4.2 million by 2034.
Hospital executives and health policy experts warn that the consequences of the law will be severe, particularly in non-expansion states. The law will limit financing arrangements that states used to make higher Medicaid payments to doctors and hospitals, which will lead to reduced reimbursement rates and potentially force rural hospitals to close.
The enhanced ACA subsidies, which are set to expire at the end of the year, have been crucial in making health insurance affordable for people like Francoise Cham, a 62-year-old single mom from Miami. If these subsidies are not extended, premiums for Obamacare coverage would rise by more than 75% on average, making it unaffordable for many people.
Health policy experts say that states that expanded Medicaid have made a smart decision, while states that haven’t are facing similar financial pressures without any upside. The budget law includes a $50 billion fund intended to insulate rural hospitals and clinics from its changes to Medicaid and the ACA, but a KFF analysis found that it would offset only about one-third of the cuts to Medicaid in rural areas.
Overall, the budget law will have far-reaching consequences for healthcare in the US, particularly in states that refused to expand Medicaid. The changes to the law will lead to increased numbers of uninsured people, reduced access to healthcare, and potentially devastating consequences for rural hospitals and communities.