Medicaid expansion under Trump could increase, if states are given more discretion over programs

Analysis from The Washington Post found that under President Trump enrollment in Medicaid under the Patient Protection and Affordable Care Act could go up, especially if Tom Price, Secretary of the U.S. Department of Health and Human Services, uses his administrative powers to grant states greater discretion in running their Medicaid programs, Timothy Callaghan and Lawrence R. Jacobs write for the Post. "Increased state discretion over Medicaid is likely to invite a new wave of Medicaid expansion in red states." (Post graphic: States with the most to gain from Medicaid expansion)

"The partisan obstacles to red states during the Obama presidency will likely ease as congressional Republicans put their fingerprints on reform," reports the Post. "Economic circumstances and administrative muscle will guide state decisions and enrollment." (Kaiser Family Foundation map: Medicaid expansion, as of Jan. 1)

"While the original ACA legislation pressured states to adopt the new expansion under the threat of losing their existing Medicaid funding, the Supreme Court’s 2012 decision in NFIB v. Sebelius granted states the ability to decide whether to adopt the program without this threat," reports the Post. "Governors in 19 states—all Republican—refused to expand the program. But the 31 states that adopted the new benefits lowered the percentage of residents who were uninsured; decreased the costs that health care providers previously paid for treating the uninsured by reducing the size of the uninsured population; and reduced the burden on state budgets with increased federal funding."

"Sixteen Republican governors accepted the Medicaid expansion, and eight are facing reelection in 2018—and they’re pressuring Congress to leave Medicaid as is," reports the Post. "That’s because the added Medicaid funding has helped state budgets while enabling those states to insure an additional 12 million people, thereby reducing the amount of unpaid medical services those states have to underwrite. However, the Trump administration will probably loosen the rules under which states administer Medicaid —giving them greater discretion than they had under Obama. We can expect Republican-run states to introduce conservative proposals, such as requiring recipients to work or to pay a fee for coverage."