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A new KFF analysis finds that a congressional proposal to significantly cut federal spending on the Affordable Care Act’s Medicaid expansion could reduce total Medicaid spending by up to nearly one-fifth, or $1.9 trillion, over a 10-year period, and end Medicaid coverage for as many as 20 million people.
In his latest Beyond the Data column, KFF’s President and CEO Drew Altman discusses how difficult it will be for states to replace lost federal Medicaid funding should Congress make significant cuts.
In the face of reduced federal funding for Medicaid, states could be left with difficult choices – raise revenue or cut spending. Cuts to Medicaid could mean eliminating coverage for children, parents, working adults or those who might need long term care; limiting benefits; or cutting rates for plans or providers.
This data note looks at Medicaid spending per full-benefit enrollee, examining variation by state and by eligibility group, as well as variation within a given state and eligibility group.
This new fact sheet examines key questions around the potential changes President-elect Donald Trump and the next Congress may seek to make in Medicaid, a program that covers 73 million people nationally.
In his latest Beyond the Data column, KFF President and CEO Dr. Drew Altman examines the controversial rural hospital grant program, noting “Will the new $50 billion rural hospital grant program in the big Republican tax and spending law just amount to a bunch of ribbon cutting and big check ceremonies, or will it help rural hospitals offset coming Medicaid cuts, help them in general, or all of the above?”
The House Committee on Appropriations approved the FY 2026 National Security, Department of State, and Related Programs (NSRP) appropriations bill and accompanying report on July 23, 2025.
The Senate Committee on Appropriations approved its FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) appropriations bill, accompanying report, and amendments on July 31, 2025.
This analysis apportions the increase in the number of uninsured across the 50 states and DC. CBO estimates that the reconciliation law will increase the number of uninsured by 10M in 2034 and rise to over 14M if enhanced premium tax credits for ACA Marketplace enrollees expire later this year.
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.
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