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When the ACA was passed in 2010, Massachusetts and six other states had federal Medicaid waivers in place that expanded coverage to people not traditionally covered by Medicaid, such as low-income childless adults. The state’s long-standing commitment to health care coverage enabled Massachusetts to achieve the highest insurance rate in the country even before the ACA was in place.

Nonetheless, the ACA increased and formalized federal funding streams for the Massachusetts coverage expansions, which were largely in place before the ACA. If the ACA were overturned today and Massachusetts could not reestablish the subsidized coverage programs that served as a cornerstone of the state’s 2006 reform, then 375,000 residents would lose coverage. The uninsured rate would climb from 3.5 percent to 10.2 percent of the nonelderly population, leaving the state worse off than it was before the ACA was implemented. The state would also lose $2.4 billion in federal funding for the state’s Medicaid program and for subsidized coverage in the state’s Marketplace.

If Massachusetts were able to reestablish its subsidized coverage programs that existed before the ACA with federal funding, then just 40,000 residents would lose coverage. The state would lose $1.4 billion in federal funding, and state spending would have to increase by $731 million. However, if the state were to reestablish its subsidized coverage program without federal funding, it would have to raise its spending on health care programs by $1.7 billion compared with current law.

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