The independent source for health policy research, polling, and news.
KFF’s policy research provides facts and analysis on a wide range of policy issues and public programs.
KFF designs, conducts and analyzes original public opinion and survey research on Americans’ attitudes, knowledge, and experiences with the health care system to help amplify the public’s voice in major national debates.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the organization’s core operating programs.
In a new column, Dr. Drew Altman, KFF's President and CEO, examines the different counts of the number of people on Medicaid that are currently in use, which range from 69 to 83 million, and why it might matter. He also discusses other ways to assess the reach of the program: “possibly it’s useful to explain why there are different numbers out there about what seemingly is an all-time simple question: how many people are on Medicaid,” Altman says.
Prior KFF analysis allocated CBO’s federal Medicaid spending reductions and enrollment losses across the states, and this policy watch builds on that analysis to examine the potential impacts in expansion states compared with non-expansion states.
On May 22, the House passed a reconciliation bill, the One Big Beautiful Bill Act, which would partially pay to extend expiring tax cuts by cutting Medicaid. The Congressional Budget Office (CBO) estimates that the bill would reduce federal Medicaid spending by $793 billion over ten years and 10.3 million fewer people would be enrolled in Medicaid in 2034, including 1.3 million people with Medicare, otherwise known as “dual-eligible individuals”.
Taken together, the reconciliation bill's provisions impose additional administrative burdens on state-based marketplaces and could limit state flexibility in choosing marketplace policies and procedures.
The Congressional Budget Office’s (CBO) latest estimate shows that the One Big Beautiful Bill would reduce federal Medicaid spending by $793 and that the Medicaid provisions would increase the number of uninsured people by 7.8 million. Previous CBO estimates show that 10.3 million fewer people would be enrolled in Medicaid in 2034. Building on prior KFF analysis, this analysis allocates these estimated federal spending reductions and enrollment losses across the states.
In his latest column, President and CEO Drew Altman shows how proposals contained in the House reconciliation bill could result in a one-third reduction in ACA Marketplace enrollment. “While all eyes are on the big Medicaid cuts being proposed in the House,” he writes, “significant changes are also being proposed that together would dramatically reduce enrollment in the ACA Marketplaces.”
The interactive maps illustrate how many people are enrolled in Medicare and Medicaid in each congressional district, including the number of people receiving full Medicaid and partial Medicaid benefits.
This brief considers how default enrollment into Medicare Advantage might work, potential challenges with this approach, and implications for beneficiaries, insurers, providers, agents and brokers, and the federal budget.
This analysis examines the potential impacts on states and Medicaid enrollees of implementing a per capita cap on the federal share of Medicaid spending for the ACA Medicaid expansion population only, which is another proposal that has been discussed by members of Congress.
© 2025 KFF