What’s at Stake In the Fight to Sustain Medicare, Medicaid and the Affordable Care Act (ACA)

Congress will soon vote on measures that will significantly affect access to health care for tens of millions of people insured through the Affordable Care Act (ACA), Medicare, and Medicaid. A vote that affects one of these programs will affect access to care through the others as well. For example, the Affordable Care Act expanded access to Medicaid in 31 states and the District of Columbia, reduced beneficiary out-of-pocket costs for Medicare Part D drugs, added many no-cost Medicare preventive benefits, and extended Medicare solvency by approximately 11 years. Thus, a vote to repeal the Affordable Care Act would impact access and coverage for health care in Medicare and Medicaid, as well as for people directly covered through ACA. The chart below highlights some of what’s at stake in the fight to maintain these essential health care programs.

How many people in the US have ACA Marketplace coverage? As of March 31, 2016: 11.1 million people[1]
How many people have access to health insurance due to expanded Medicaid coverage under ACA? (31 states and DC) In 2015 11 million people had coverage through Medicaid expansion under ACA[2]
How many people have Medicaid 81 million in 2015[3]
How many people are enrolled in Medicare? In 2015 there were 55.5 million people enrolled in Medicare[4]
How many people are enrolled in Medicare and Medicaid? (Dually eligible) 10,842,000 people in 2013 (latest figure available)[5]
Which 19 states did not expand Medicaid Alabama, Florida, Georgia, Kansas, Idaho, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Texas, Tennessee, Utah, Virginia, Wisconsin, Wyoming[6]
How many people gained access to Medicaid/CHIP after the ACA was passed? 16,748,000 people gained access to Medicaid health insurance because of the ACA as of September 2016.[7]

“I will be on the streets at 66 yrs old without Medicare/Medicaid.  It’s as simple as that.  My money has all gone raising 3 granddaughters after their mother died.  There are millions of stories like mine everywhere.  We must help the least of us that had bad luck or are sick etc.”

J.D., Medicare Beneficiary, Michigan

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“I am 71 years old and my only income in retirement is Social Security.  Medicare is my healthcare insurance. Both Social Security and Medicare are working just fine for me as is. Privatizing either one of these would just reduce my benefits since the private providers would want to take profits.”

F.W., Medicare Beneficiary, Wisconsin

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“I am a disabled woman. I have brittle bones and need to use an electric wheelchair. Without Medicare I will die.”

L.R.B., Medicare Beneficiary, Louisiana

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“In 2013 I lost my job due to sickness and am still unemployed, jobless and on disability but before I was granted Medicare I was about to lose my health insurance. I worked as a Microbiologist for the state of Tennessee and had to paid the full cost of the state insurance, which I barely could afford but along came this thing called the Healthcare act/Obamacare. I did have trouble getting it but I finally succeeded and for the next two years I had affordable healthcare at a price I was glad of and for the many back surgeries and infections it was a life saver.”

J.S., ACA and Medicare Beneficiary, Tennessee


[1] CMS. “March 31, 2016 Effectuated Enrollment Snapshot.” 30 June 2016.  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html (site visited December 29, 2016).
[2] Robin Rudowitz, Samantha Artiga, and Katherine Young. “What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion?” Kaiser Family Foundation. 06 December 2016. http://kff.org/medicaid/issue-brief/what-coverage-and-financing-at-risk-under-repeal-of-aca-medicaid-expansion/  (site visited December 29, 2016).
[3] MACPAC. “Medicaid and CHIP Enrollment as a Share of the U.S. Population, 2015 (Millions).” December 2016. https://www.macpac.gov/wp-content/uploads/2015/01/EXHIBIT-1.-Medicaid-and-CHIP-Enrollment-as-a-Share-of-the-U.S.-Population-2015.pdf (site visited December 30, 2016).
[4] Kaiser Family Foundation. “Total Number of Medicare Beneficiaries.” http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/?currentTimeframe=0 (site visited December 29, 2016).
[5] MACPAC. “Medicaid Enrollment by State, Eligibility Group, and Dually Eligible Status, FY 2013 (Thousands).” December 2016. https://www.macpac.gov/wp-content/uploads/2015/01/EXHIBIT-14.-Medicaid-Enrollment-by-State-Eligibility-Group-and-Dually-Eligible-Status-FY-2013.pdf (site visited December 30, 2016).
[6] Kaiser Family Foundation. “Current Status of State Medicaid Expansion Decisions.” 14 October 2016. http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/ (site visited December 29, 2016).
[7] Kaiser Family Foundation. “Total Monthly Medicaid and CHIP Enrollment.” http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/?currentTimeframe=0 (site visited December 30, 2016).