The House health care bill would require many states that expanded Medicaid under the Affordable Care Act to pay much more for their newly eligible enrollees beginning in 2020. Here's what it would look like, based on projections from Republican Sen. Bill Cassidy's office:

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Data: Government Accountability Office data analyzed by Sen. Bill Cassidy's office; Table: Andrew Witherspoon / Axios

Why states would have to spend so much more:

  • For newly eligible people who sign up before 2020, the federal government will keep paying for 90 percent of their costs — the higher matching rate under the Affordable Care Act.
  • But if they sign up starting in 2020, they only get the state's regular matching rate. In California, for example, this is 50 percent.
  • So the state goes from paying 10 percent of that person's costs under the ACA to paying 50 percent of his or her costs.
  • Massachusetts, Vermont and Montana also expanded Medicaid, but they've been left off of this list. Massachusetts and Vermont already had generous state Medicaid laws, so the ACA treated them differently. Montana expanded late, so data was unavailable.
  • These projections are based on 2016 spending. They don't account for variables like changes in the population or increased medical spending.

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