Congress is currently debating whether and how to repeal and replace the Affordable Care Act (ACA). This report provides an analysis of the potential impact to the State of Montana of a possible repeal of one portion of the ACA—the Medicaid expansion and the enhanced federal match to cover that expanded care. Federal decisions regarding Medicaid expansion would affect access to healthcare for over 71,000 Montanans covered under Montana’s bipartisan Health and Economic Livelihood Partnership (HELP) Act. In Montana and the 30 other states that expanded Medicaid, over 11 million people have gained coverage since 2014; all are at risk of losing that coverage should Congress determine to repeal the ACA’s Medicaid expansion.

This report analyzes the impact of Medicaid expansion in Montana and contemplates the ramifi cations of its repeal on access to coverage and care, the State budget, and the broader economy, finding that expansion in Montana has resulted in...