How Medicaid Expansion Supports Access to Care

February 24, 2025

The Affordable Care Act’s Medicaid expansion serves an important role to connect millions of Americans to quality health care.

A new analysis from the Kaiser Family Foundation (KFF) indicates that a proposal to significantly cut federal spending on Medicaid expansion would impact as many as 20 million people. The analysis comes as lawmakers consider Medicaid’s future during budget talks. Here’s what you need to know:

• Background:  The Affordable Care Act offers federal support to states to expand their Medicaid programs, providing up to 90 percent of the costs to cover the expansion population.
  • Pennsylvania and 39 other states have adopted Medicaid expansion with the additional federal funding.
• What they found:  If the federal government stopped providing funds for the expansion population, Medicaid funding would decline by $1.9 trillion; federal spending on the program would decline 25 percent over 10 years.
  • States would need to increase spending by 17 percent or add $626 billion to make up the loss of federal funding.
• In Pennsylvania:  In 10 years, total enrollment would decline by 829,000 if the federal funding went away and the state did not make up the difference.
  • Without the federal expansion funding, the state would have to replace $27 billion to make up the difference.
• Quotable:  “Eliminating the Medicaid expansion match is one of several options under consideration by Republicans in Congress to reduce Medicaid spending to help pay for an extension of the 2017 tax cuts,” KFF said in a news release. “Medicaid provides health coverage to low-income Americans and accounts for nearly $1 out of every $5 spent on health care in the U.S.

Last week, HAP sent a letter urging Pennsylvania’s congressional delegation to protect Medicaid funding and other priorities that support access to care. The KFF analysis is available online.