AZ on the Brink: Millions Face Health Care Loss as Trump and GOP Eye Medicaid Cuts

Following Donald Trump’s anticipated return to the White House in 2025, Republican control of Congress puts the Affordable Care Act’s Medicaid expansion at significant risk. A new analysis indicates that more than 3 million adults across nine states could lose their health coverage if the GOP proceeds with cuts to federal Medicaid funding.

The states at risk include Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia. These states possess trigger laws that would instantly cease their Medicaid expansions if federal funding diminishes.

Enacted in 2010, the Affordable Care Act aimed to broaden Medicaid to encompass low-income individuals without job-based health insurance. Since 2014, 40 states and the District of Columbia have participated, granting insurance to an estimated 21 million people and contributing to a notable decline in the uninsured rate.

In most scenarios, the federal government finances 90% of the costs for this expanded population, significantly exceeding the usual 57% match for other Medicaid beneficiaries. Conservative groups typically oppose the ACA, arguing that it is unaffordable and overly extensive. Conversely, Democrats emphasize the program’s role in saving lives and enhancing community health access.

The implications of a reduction in federal funding would extend beyond the nine states with trigger laws. Even states without such laws could face severe cuts, forcing local legislatures to compensate for lost funds. Renuka Tipirneni, an associate professor at the University of Michigan, noted that the political climate in each state could heavily influence whether expansions are maintained or terminated.

In states that backed Trump in the 2024 election, such as Indiana and North Carolina, the situation remains particularly precarious. Trigger laws in these states generally activate if federal support drops below the critical 90% threshold, with Arizona being more stringent at a cutoff of 80%.

Montana’s expansion policy stipulates that coverage can continue if state lawmakers find alternative funding, but it requires reauthorization by 2025. According to KFF and Georgetown researchers, the potential gap in coverage could affect between 3.1 million and 3.7 million individuals, depending on how states process previous Medicaid additions.

Including states like Iowa, Idaho, and New Mexico— which have laws to mitigate the financial impact of cuts but would not automatically end expansions—approximately 4.3 million people could be affected. The ACA permits Medicaid expansions to individuals with incomes up to 138% of the federal poverty level, which equates to about $20,783 for a single person in 2024.

Out of the 81 million Medicaid enrollees nationally, nearly a quarter are due to the expansions. Robin Rudowitz, vice president at KFF, emphasizes that a reduction in federal support could prompt all states to reassess their Medicaid programs, likely resulting in an uptick in uninsured individuals and limited care access across both red and blue states.

State lawmakers often avoid making cuts to critical social programs like Medicaid once they are implemented. The presence of trigger laws simplifies the process of terminating expansion, as lawmakers would not need to undertake new actions to reduce coverage.

Historically, trigger laws have exemplified how conservative lawmakers can swiftly enact policy changes. A similar situation unfolded post-2022 after the Supreme Court overturned Roe v. Wade, prompting immediate abortion bans in various states with preexisting trigger laws.

Looking to the future, uncertainty surrounds how Trump and congressional Republicans will approach Medicaid. A recent recommendation from the Paragon Health Institute suggests a gradual decline in the federal match for expansions, transitioning to align with state-specific Medicaid funding levels by 2034.

Experts, including Daniel Derksen from the University of Arizona, doubt that Arizona will opt to eliminate its trigger law due to the financial burdens that would ensue. Past Republican efforts to cut Medicaid funding have met with failure, yet the momentum to alter the ACA continues.