Under the U.S. Senate's Better Care Reconciliation Act, the 19 states that did not expand Medicaid under the Affordable Care Act will forego $737 billion in net federal Medicaid outlays throughout a decade compared to states that have opted to expand the program. Researchers from the Hospital Industry Data Institute, on behalf of numerous non-expansion states, reviewed the U.S. Senate's BCRA to identify how federal funds would flow to expansion and non-expansion states. They found a continued significant imbalance in federal spending in expansion states even after accounting for the restoration of cuts included in the ACA and additional safety-net funds included in the BCRA.
The recently released policy brief explains BCRA's influence on the states that did not expand Medicaid and illuminates the significant federal funding inequity that exists. On a per capita basis, net federal expenditures for full-expansion states increased 91 percent between 2013 and 2015, while partial-expansion states — those with Section 1115 waivers — experienced 71 percent growth. The 19 states that did not expand Medicaid under the ACA experienced a 13 percent increase. Combined, in 2015, Medicaid expansion states received $1,578 per capita in federal Medicaid spending compared to $753 per capita in non-expansion states — a relative difference of 110 percent.