Senator Collins paved the way for Republican lawsuit that now threatens MaineCare expansion

A new report from the Kaiser Family Foundation examined what would happen to the millions of Americans covered by the Affordable Care Act’s Medicaid expansion if the health care law is overturned in a lawsuit made possible by Senator Collins. 

The report found that if the ACA is overturned, most of the 15 million Americans covered by Medicaid expansion would become uninsured. That would include the more than 60,000 Mainers who have gained coverage since Governor Mills expanded Medicaid on her first day in office. Additionally, other gains in access and affordability in addressing income and racial disparities in health coverage and health outcomes could be lost if the ACA is overturned.

The Supreme Court is set to hear arguments next month in California v. Texas, where the Trump administration is arguing that the entire Affordable Care Act should be overturned. Senator Susan Collins paved the way for the Republican lawsuit when she cast a decisive vote for the 2017 GOP tax giveaway that repealed the individual mandate. The Trump Administration’s lawsuit argues that Senator Collins and Senate Republicans “knowingly voted to destroy the health care law” with their tax vote.

Kaiser Family Foundation: Eliminating the ACA: What Could It Mean for Medicaid Expansion?

By: Rachel Garfield and Robin Rudowitz|
October 1, 2020

Key Points:

  • The debate over filling the Supreme Court seat previously held by Ruth Bader Ginsburg has brought renewed attention to the possibility of the Affordable Care Act (ACA) being overturned under the court challenge in California v. Texas, currently scheduled to be heard shortly after the election this November. The expansion of Medicaid was a central component of the ACA, and 39 states have now adopted the ACA expansion into their Medicaid programs.
     
  • Overturning the ACA would eliminate a Medicaid coverage pathway and federal Medicaid financing for millions of people. As of June 2019, 15 million people were enrolled in the ACA Medicaid expansion group and about 12 million of them were newly eligible under the ACA (the remainder were adults covered with waivers prior to the ACA and then moved to the ACA expansion group). This number could be even greater as enrollment has been increasing since February due to the pandemic and its related economic effects. 
     
  • If the ACA is overturned, these individuals lose their federal entitlement to coverage and states cannot claim 90% federal matching dollars for their Medicaid costs. According to the Congressional Budget Office, the federal government is expected to pay $82 billion in FY 2020 for coverage for adults made eligible by the ACA.  It is most likely that states would not continue to finance coverage for these individuals with the regular Medicaid match or with state only funds, and most would likely become uninsured.
     
  • Overturning the ACA would eliminate the eligibility pathway for adults without dependent children that was created by the law as well as state access to federal matching funds for Medicaid coverage of this group. States that wished to continue to cover this group would need to either seek a waiver from the Secretary of HHS or use only state dollars to finance the coverage. 

  • Because the federal government is currently financing 90% of the cost of expansion – even more than the traditional match rate in Medicaid that ranges from 50% to 78%— transitioning the full cost to state budgets likely would not be possible within state budget constraints.

  • What happens to people covered by the expansion if the law is overturned or repealed? Most would likely become uninsured. Though most adults without disabilities who are covered by Medicaid are working, offer rates of employer-based insurance are very low for workers with incomes below Medicaid eligibility levels.

  • Repealing or overturning the ACA would further eliminate other provisions that could help lower-income people access private coverage, such as protections for people with pre-existing conditions and premium subsidies in the ACA marketplace.

  • While a limited number of states had waivers to cover adults without dependent children prior to the ACA, it is not certain that even these states would maintain ACA coverage through a waiver without enhanced federal funding, particularly given the current economic realities and revenue shortfalls states are facing related to the pandemic.

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