Senior Policy Analyst
The Justice Department’s recent announcement that it now supports a district court decision that would strike down the entire Affordable Care Act (ACA) puts even more at stake for Medicaid than is commonly understood — in the unlikely event that higher courts uphold the decision. In addition to eliminating the ACA’s Medicaid expansion to low-income adults, the decision would put other Medicaid initiatives at risk and create massive disruption for state Medicaid programs, even in non-expansion states.
To be sure, the ACA’s most significant Medicaid change is its expansion to adults with incomes below 138 percent of the federal poverty line, which let millions gain Medicaid coverage for the first time and produced significant benefits for them, their families, and their communities, research shows. If the ACA is struck down, almost 13 million low-income adults would lose their health insurance and, with it, access to treatment for chronic conditions, mental illness, and substance use disorders. It would also cause greater financial instability for safety net providers, such as hospitals, because they would incur greater uncompensated care costs due to the higher number of uninsured adults.
But that’s not all. If the Administration’s position prevails, it would also:
Fortunately, the ACA remains the law of the land for now. And the legal reasoning behind the district court decision is weak; even some of the ACA’s most committed opponents predict it will be overturned. But if it were upheld, as the Administration is urging, the harm to tens of millions of Medicaid enrollees, not just those enrolled through the ACA expansion, would be severe.