Kaiser Health News has created a special website to keep track of news about changes to the Affordable Care Act. KHN says it will provide analysis, explanation, investigation and data on its site called Repeal & Replace Watch. You can bookmark this on your browser.

A new study from the Commonwealth Fund finds that repeal of two major federal spending provisions of the Affordable Care Act, insurance premium tax credits and the expansion of Medicaid, would ultimately lead to the loss of 2.6 million jobs in 2019. The data, generated by researchers at George Washington, breaks down the impact of repeal for each state. California would lose the most jobs, 334,000 their multistate economic forecasting model suggests, and Wyoming the least with 4,000 jobs lost.

A new study out of Michigan concludes that the state’s Medicaid expansion is to the state’s financial advantage.

When the legislature approved the expansion in 2013, it required that Michigan achieve other health care savings and revenue to offset the state match required starting Jan. 1, 2017 – or the state would reverse its expansion.

Health policies and programs in the states face an uncertain future with the election of Donald J. Trump. During his campaign he vowed to repeal the Affordable Care Act.

Currently 73 million Americans are enrolled in the Medicaid program, a federal-state partnership program for which the federal government pays 62 percent of total expenditures. A Medicaid block grant, one proposal under discussion, might provide the states more flexibility but also might transfer more financial responsibility, especially in the long term, to the states. 

An article in today's Kaiser Health News suggests that a President Trump could dismantle much of the Affordable Care Act without Congressional action. For instance, just a stroke of his presidential pen could eliminate subsidies to persons between 100 and 250 percent of the poverty level. On the other hand, Clinton's proposals to support and build on the ACA would seem to require Congressional action. 

More than 20 legislators from 16 states--many of them in key leadership positions on health or budget committees that deal with Medicaid in their home states--attended a CSG policy academy in Washington D.C. on September 21-23, 2016, to learn how states are making reforms in their Medicaid program that pursue the health "triple aim": improving the quality of care for individuals, improving the health of populations, and reducing per capita costs of health care.

A comparison of U.S. Census data for 2013 and 2014, released in early 2016, shows that a greater portion of Americans in each state had health insurance in the more recent year. Nearly 8.5 million individuals gained health insurance coverage between 2013 and 2014. In 2014, all the provisions of the Affordable Care Act designed to increase access to affordable insurance were in place for states. Some states, however, decided not to expand income eligibility for Medicaid to 138 percent of the federal poverty level as the Supreme Court ruled in 2012 was the prerogative of the states, not Congress. The states that showed the greatest increase in coverage between 2013 and 2014 were states that expanded Medicaid income eligibility.

Gov. Matt Bevin, elected in November 2015 and who had pledged during his campaign to eliminate Medicaid expansion which brought health coverage to 400,000 previously uninsured individuals, announced yesterday his plan to transform Kentucky’s Medicaid system through an 1115 waiver. The new waiver will cover almost all the Medicaid enrollees eligible under the pre-expansion rules as well as all the newly eligible under the expansion rules.

Bevin said his plan is an opportunity “to come up with what is going to be truly a transformative and sustainable and fantastic program,” according The Courier-Journal coverage of the press conference. He pledged to both save money—$2.2 billion in combined state and federal funding over the next five years—and reduce the number of Medicaid enrollees—86,000 people by 2021 by moving them to private insurance.  

Despite pushing the federal government to provide 100 percent of the cost for health care for American Indians, what South Dakota Gov. Daugaard has characterized as a longstanding treaty obligation, on Feb. 29 Daugaard ruled out Medicaid expansion during this legislative session.

Last week, two states rejected Medicaid expansion, another is continuing negotiations with Washington and one is studying whether and how to continue expansion already in place and reduce the numbers of people eligible. Currently 31 states and the District of Columbia have expanded income eligibility for Medicaid as provided for by the Affordable Care Act. Sixteen states remain firmly in the non-expansion column.

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