Senior Policy Analyst
The Senate Republican bill to repeal the Affordable Care Act (ACA) would effectively end the ACA’s Medicaid expansion starting in 2021, leaving millions of low-wage workers who gained coverage through the expansion uninsured and without access to needed care, as we detail in several new state fact sheets.
Our fact sheets show how these Medicaid expansion coverage losses would affect low-wage workers across employment sectors in seven states: Arizona, Arkansas, Colorado, Nevada, Ohio, Pennsylvania, and West Virginia. In Nevada, for example, 35,000 people who work in the state’s robust entertainment sector — such as those who work (or have recently worked) in restaurants and other food services, gambling, and hotel industries — would lose their Medicaid coverage if policymakers repeal the expansion (see graphic).
The Senate bill isn’t fixable: every major element would cause people to lose coverage, make coverage less affordable or less comprehensive, or cut taxes for high-income people. Along with effectively ending the Medicaid expansion, it would radically restructure virtually all of Medicaid to a per capita cap starting in 2020. The bill would cut federal Medicaid spending by $772 billion over the next ten years and reduce enrollment by 15 million by 2026, relative to current law.
The bill would particularly harm millions of low-income working individuals and families whose jobs don’t offer health coverage. In 2015, only 57 percent of employers nationally offered health benefits to their employees, even with the ACA’s mandate that employers with more than 50 employees offer coverage, which the Senate bill would eliminate. Many low-income employees who don’t get coverage through their jobs rely on Medicaid for themselves and their families; under the Senate bill, they’d likely lose their Medicaid expansion coverage and be unable to afford private insurance in the individual market.
At the same time that the bill would effectively eliminate the Medicaid expansion, it would sharply reduce tax credits to help low- and middle-income families afford individual market health coverage and repeal the ACA’s cost-sharing subsidies that reduce consumers’ out-of-pocket costs. The combination of Medicaid cuts and subsidy reductions for individual market coverage would increase the likelihood that many low-wage workers would go uninsured — putting them and their families at risk of going without the health care they need.