Both the Senate’s Better Care Reconciliation Act of 2017 (BCRA) and the House’s American Health Care Act (AHCA) go beyond repeal and replacement of the Affordable Care Act (ACA) to make fundamental changes to Medicaid by setting a limit on federal funding through a per capita cap or block grant. The BCRA also includes additional changes that would further reduce federal spending for states with high per enrollee spending, limit state financing mechanisms, allow states to impose work requirements, and make other eligibility changes. Across the board, these changes would have significant implications for the 74 million people covered by the Medicaid program and for states that jointly finance and administer the program. This brief explains the five most significant Medicaid changes in the BCRA as well as additional Medicaid changes that could have major implications for states, providers, and beneficiaries.
President Donald Trump and Republicans in Congress pursued several major efforts to repeal and replace the Affordable Care Act (ACA) but were unable to get a bill through the U.S. Senate in 2017. In 2018, Congress did pass a tax bill that eliminated the ACA’s tax penalty for not obtaining health coverage beginning in 2019.
In December 2019, a federal appeals court panel ruled that the law’s individual mandate is unconstitutional since Congress has set the mandate tax penalty to zero and sent the case back to a lower court to determine how much of the rest of the ACA should be invalidated. The case was first brought by a number of Republican state attorneys general, and the Trump administration now argues that nearly all of the ACA should be overturned. The U.S. Supreme Court has now agreed to review the case.
For information about ACA Marketplace Open Enrollment, including fact sheets and 300+ FAQs, visit our collection of resources on Understanding Health Insurance.
Featured Affordable Care Act Resources
On December 14, 2018, a federal trial court judge ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional and that the entire law should be struck down as a result. This brief considers the complex and far-reaching impact were the entire law ultimately held to be invalid.
Fact Sheet See More
Related Affordable Care Act Resources
- Explaining Texas v. U.S.: A Guide to the Case Challenging the ACA
- The Past, Present, And Possible Future Of Public Opinion On The Affordable Care Act
- Republican Voters Have Moved On from Hating the ACA
- The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review
- FAQs: Health Insurance Marketplace and the ACA
- Status of State Medicaid Expansion Decisions: Interactive Map
- How ACA Marketplace Premiums Are Changing by County in 2020
- Insurer Participation on ACA Marketplaces, 2014-2020
- Pre-Existing Condition Prevalence for Individuals and Families
- Preventive Services Tracker
As unemployment claims skyrocket amid the coronavirus (COVID-19) crisis, this analysis examines the potential loss of job-based coverage among people in families where someone lost employment between March 1 and May 2 and estimate their eligibility for ACA coverage as of May and January 2021, when most will have exhausted their unemployment benefits.
Issue Brief See More
- view as grid
- view as list
This brief describes Medicaid’s role for veterans experiencing homelessness and provides insight into how the Affordable Care Act (ACA) Medicaid expansion has affected their coverage and access to care.
This data note analyzes federal funding changes for Affordable Care Act (ACA) marketplace navigators in 2017 and discusses the implications for both the navigators and consumers. It presents results of a Kaiser Family Foundation online survey of federal marketplace (FFM) navigator programs and includes insights from a roundtable meeting of more than 40 navigators co-hosted by the Robert Wood Johnson Foundation and Kaiser Family Foundation.
The Independent Payment Advisory Board was authorized by the Affordable Care Act to help slow the growth in Medicare spending. These FAQs address common questions about IPAB, including how it was designed to operate and the implications of eliminating it.
The Individual Mandate Penalty Calculator estimates your penalty for going uninsured vs. how much you would pay for health insurance coverage on the Affordable Care Act (ACA) marketplaces.
New Individual Mandate Penalty Calculator Helps Consumers Estimate Their Penalty for Being Uninsured in 2018
A new individual mandate penalty calculator from the Kaiser Family Foundation allows consumers to estimate how much they would owe as a tax penalty for lacking health coverage in 2018, and to compare that amount to the cost of the least expensive 2018 Affordable Care Act marketplace plan in their…
In this Axios column, Drew Altman examines the role of health care in Virginia’s elections and the referendum on Medicaid expansion in Maine. His assessment: the elections and the referendum will have a bigger impact on upcoming policy debates about cutting Medicaid to pay for tax cuts, and state interest in Medicaid expansion, than on upcoming elections.
As Republicans in Congress continue efforts to pass tax reform, the November Kaiser Health Tracking Poll examines views of the plans and how they relate to health care issues. Overall, reforming the tax code is seen as a “top priority” for President Trump and Congress by about three in ten (28 percent), falling well-behind several health care issues such as reauthorizing funding for the State Children’s Health Insurance Program (CHIP) (62 percent) and stabilizing the ACA marketplaces (48 percent). In addition, the majority of the public (55 percent) support the idea of eliminating the requirement for all Americans to have health insurance or else pay a fine as part of the Republican tax plan, however views vary party. In contrast, the majority of the public (68 percent), including majorities across parties, oppose eliminating the tax deduction for individuals who have high health care costs. The poll also takes an early look at the public’s views of the potential consequence of Congress not passing tax reform or repealing the ACA before the 2018 midterms.
State-by-State Estimates of Changes in Federal Spending on Health Care Under the Graham-Cassidy Bill
A new health care bill recently introduced by a number of senators led by Senators Lindsey Graham and Bill Cassidy would repeal major elements of the Affordable Care Act (ACA), make changes to other ACA provisions, and fundamentally alter federal Medicaid financing. In this brief, we estimate changes in federal funding due to the new block grant program and the Medicaid per enrollee cap on a state-by-state basis under the Graham-Cassidy bill relative to current law. We estimate that the Graham-Cassidy proposal would reduce federal funding for health coverage by $161 billion nationally from 2020-2026, with substantial variation across states.
Graham-Cassidy-Heller-Johnson Plan to Replace ACA Funding With a New Block Grant and Cap Medicaid Would Decrease Federal Funding for States by $160 Billion from 2020-2026; Then a $240 Billion Loss in 2027 if the Law is Not Reauthorized
The Senate is preparing to vote next week on the Graham-Cassidy proposal to repeal and replace the Affordable Care Act and to cap the Medicaid program. A new state-by-state Kaiser Family Foundation analysis finds that the major financing changes in the bill would reduce federal spending by $160 billion over…