The Great Medicaid Divide
In his Axios column, Drew Altman examines how the core views Republicans have about Medicaid differ from those of Democrats and Independents, and how those views drive the policy changes they are proposing for the program.
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This analysis of insurers’ initial rate filings for Affordable Care Act Marketplace plans in all 50 states and DC finds the median proposed increase for 2026 is 18%, more than double last year’s proposed increase. The analysis also shows proposed rate changes by state and insurer.
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.”
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In his Axios column, Drew Altman examines how the core views Republicans have about Medicaid differ from those of Democrats and Independents, and how those views drive the policy changes they are proposing for the program.
Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps. Faced with restrictions in federal financing, states would have to make hard choices. This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap: raise taxes or make other cuts, reduce benefits, limit coverage of high cost enrollees, reduce rates or implement delivery system reforms, and promote personal responsibility. Each option has challenges that are identified in the brief.
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This map shows the counties at risk of having no insurer on the marketplace (exchange), created by the Affordable Care Act, in 2018, based on a Kaiser Family Foundation analysis of insurer rate filings and news reports.
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