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Why 2020 May Trump Medicaid Rollback

The House GOP’s Obamacare replacement plan — already labeled “Trumpcare” — rolls back Medicaid growth in 2020. Why that may never actually happen.

AHCA

On Monday evening, the House GOP rolled out the American Health Care Act (AHCA), its replacement for Obamacare. President Trump said on Tuesday he is “proud” to support the plan but faces a tough sell with skeptical conservatives (and some moderate GOP senators).

One key provision in the AHCA is a “freeze” in Medicaid enrollment starting on January 1, 2020, then shifting the decades-old program to a “per capita cap” system rather than an open-ended benefit. This will likely lead to less Medicaid enrollees over time.

One big obstacle stands in the way of Medicaid rollback, though: the 2020 election.

Assuming President Trump — and a slew of GOP senators, as well as 200-plus GOP House members — are up for re-election in 2020, this planned Medicaid rollback will be difficult for leadership to swallow for two reasons:

#1: RED STATES EXPANDED MEDICAID

Thirty-two states, plus D.C., expanded Medicaid under Obamacare. Several of those states went for Trump in 2016 and are key to his re-election prospects, including Ohio, Pennsylvania, Michigan, and Arizona.

Kaiser Family Foundation (KFF) has a map of which states have expanded Medicaid:

Medicaid Expansion Map

Trump won 13 of the 32 states that expanded Medicaid.

#2: SWING STATES DEPEND ON MEDICAID

Another KFF map takes a look at Medicaid recipients by state and, again, there’s some overlap with the Trump victory map:

KFF's Monthly Medicaid Map

Trump won all four states (MI, OH, PA, NC) that have between 1.5 million and 2.3 million Medicaid recipients today (all are in the Top 10 for states with Medicaid recipients).

What’s more, Trump won two of the five states (TX and FL) that have 2.6 million or more Medicaid recipients today. Texas and Florida, along with California, Illinois and New York, are the top five states for total number of Medicaid recipients.

Will Trump run into this electoral buzzsaw as the Medicaid “freeze” date approaches, and lies just 11 months before he tries to win re-election? Time will tell, but the AHCA process is guaranteed to be a long one.