A Court Ruling Striking Down the ACA Would Eliminate the Medicaid Expansion and Cause Millions of Low-Income People to Become Uninsured

Millions of low-income Americans currently covered by Medicaid likely would become uninsured if the Supreme Court were to strike down the Affordable Care Act in California v. Texas, a legal challenge the high court is scheduled to hear in early November, KFF experts explain in a new Policy Watch post.

Overturning the ACA would eliminate the expansion of Medicaid, which largely has been financed by the federal government, and eliminate eligibility for Medicaid for low-income adults without dependent children. Fifteen million people were enrolled in the ACA Medicaid expansion group as of last year, including 12 million who were made newly eligible under the health law (the remainder were adults covered with waivers prior to the ACA and then moved to the ACA expansion group).

If the ACA were overturned, these individuals would lose their federal entitlement to coverage and states would no longer be able to claim 90 percent federal matching dollars for their Medicaid costs. It is most likely that states would not continue to finance coverage for these individuals, and given limited other options for affordable coverage absent the ACA, most would likely become uninsured.

Eliminating the Medicaid expansion would also have implications for state budgets and economies, as well as provider capacity and the financial health of hospitals and other health care providers.

A related Policy Watch post highlights how the ACA’s new coverage options, including the Medicaid expansion and subsidized private plans on the ACA marketplace, have contributed to large gains in coverage among people of color, helping to narrow longstanding racial disparities in coverage. The elimination of these coverage pathways would likely lead to disproportionate coverage losses among people of color, reversing trends and widening disparities in coverage, access to care, and health outcomes.

For more data and analyses regarding the ACA and Medicaid expansion, visit kff.org.