• 10 Things to Know About Medicaid (Alice Burns, Elizabeth Hinton, Robin Rudowitz, and Maiss Mohamed, KFF, 2-18-25) Whether subsidies expire at the end of this year or in two or three years, their expiration would result in the steepest increase in out-of-pocket premium payments most enrollees in this market have seen. Because the Inflation Reduction Act extends the enhanced subsidies for three years and not permanently, future Marketplace enrollees may see steep premium increases when the subsidies eventually expire.
Among potential changes to Medicaid through executive actions (under Trump!), this brief highlights ten key things to know about Medicaid (go to the source for full copy).
1. Nationally, one in five people have Medicaid, but this varies across the states (see map).
2. Medicaid is a key source of coverage for certain populations (see chart).
3. Medicaid is jointly financed by the federal government and states (see map).
4. Medicaid accounts for one fifth of all health care spending, and over half of spending on long-term care (see chart).
5. People who qualify for Medicaid based on age or disability account for more than half of spending I (see chart).
6. Flexibility to administer Medicaid results in variation in per enrollee costs across states (see map).
7. Three-quarters of all Medicaid enrollees receive care through comprehensive, risk-based MCOs. 8. Medicaid coverage facilitates access to care, improves health outcomes, and provides financial protection from medical debt.
9. Section 1115 demonstration waivers reflect changing priorities across presidential administrations.
10. The majority of the public holds favorable views of Medicaid.
In the most recent KFF tracking poll, more than three-fourths (77%) of Americans held favorable views of Medicaid, including six in ten Republicans (63%), and at least eight in ten independents (81%) and Democrats (87%) (Figure 10). Medicaid is also viewed favorably by a majority of voters who say they voted for President Trump in the 2024 election (62%). Nearly half of the public (46%) say the federal government doesn’t spend enough on the Medicaid program, with another third (33%) saying it spends “about the right amount,” and around one in five (19%) saying it spends “too much.”
With possible changes to government health programs, seven in ten (72%) say they are worried about the level of benefits that will be available to people covered by Medicaid in the future
Topics Medicaid Uninsured Tags Medicaid's Future Access to Care Maternal and Child Health Children Children's Health Insurance Program (CHIP) Disability Also of Interest Medicaid: What to Watch in 2025 Medicaid Financing: The Basics 10 Things to Know About Medicaid Managed Care
• Medicaid: What to Watch in 2025
• ACA Marketplace Enrollees Will See Steep Increases in Premium Payments in 2026 if Enhanced Subsidies Expire (KFF, 7-6-24) Enrollees in 12 HealthCare.gov states would see their annual payments at least double on average without enhanced subsidies
• Where ACA Marketplace Enrollment Is Growing the Fastest, and Why (Cynthia Cox and Jared Ortaliza, KFF, 5-16-24) The five states with the fastest growth in Marketplace enrollment since 2020 – Texas (212%), Mississippi (190%), Georgia (181%), Tennessee (177%), and South Carolina (167%) – have certain characteristics in common: They all started off with high uninsured rates before the enhanced subsidies rolled out, they have not expanded Medicaid under the ACA, and they all use the Healthcare.gov enrollment platform.
• What Does the Federal Government Spend on Health Care? (Juliette Cubanski, Alice Burns, and Cynthia Cox, Medicaid, KFF, 2-24-25)
The federal government spent $1.9 trillion on health care programs and services in fiscal year (FY) 2024, 27% of all federal outlays in that year, and collectively the largest category of federal spending.
Forgone tax revenues to the federal government resulting from tax subsidies for employer sponsored insurance coverage (ESI) and a portion of the Affordable Care Act (ACA) premium tax credits together totaled $398 billion in FY 2024.
Over 80% of all federal support for health programs and services, including spending and tax subsidies, goes to programs that provide or subsidize health insurance coverage, with
---36% going to Medicare,
---25% going to Medicaid and CHIP,
---17% going to employment-based health coverage, and
---5% going to subsidies for Affordable Care Act (ACA) coverage.
Discretionary spending is a relatively small component of overall federal support for health programs and services. Over half (52% or $128 billion) of discretionary health spending paid for hospital and medical care for veterans. Discretionary health spending also provides funding for agencies such as the National Institutes of Health (NIH, 19% of discretionary health spending) and the Centers for Disease Control and Prevention (CDC, 4%), as well as global health (4%).