When the ACA dramatically expanded the number of Medicaid patients competing for access, there was no corresponding increase in the number of Medicaid providers, which meant something had to give. Economist Liam Sigaud and I discovered in a 2022 study that expansion states had shifted Medicaid’s financial resources away from low-income children toward higher-income, able-bodied adults. Specifically, we found that “states that expanded Medicaid … spent only 5.9% more per capita on children in FY 2019 than they did in FY 2013 compared with growth of 22.7% in per capita spending on children in nonexpansion states and of 27.0% in average healthcare spending per capita for the US population as a whole.”
Source: Charles Blahous, “Medicaid Needs Commonsense, Cost Saving Reforms.”