MIAMI — GOP lawmakers in the 10 states that refused the Affordable Care Act’s Medicaid expansion for over a decade have argued their conservative approach to growing government programs would pay off in the long run. Instead, the Republican-passed budget law that includes many of President Donald Trump’s priorities will pose at least as big a burden on patients and hospitals in the expansion holdout states as in the 40 states that have extended Medicaid coverage to more low-income adults, hospital executives and other officials warn. For instance, Georgia, with a population of just over 11 million, will see as many people lose insurance coverage sold through ACA marketplaces as will California, with more than triple the population, according to estimates by KFF, a health information nonprofit that includes KFF Health News. The new law imposes additional paperwork requirements on Obamacare enrollees, slashes the time they have each year to sign up, and cuts funding for navigators who help them shop for plans. Those changes, all of which will erode enrollment, are expected to have far more impact in states like Florida and Texas than in California because a higher proportion of residents in non-expansion states are enrolled in ACA plans. The budget law, which Republicans called the “One Big Beautiful Bill,” will cause sweeping changes to health care across the country as it trims federal spending on Medicaid by more than $1 trillion over the next decade. The program covers more than 71 million people with low incomes and disabilities. Ten million people will lose coverage over the next decade due to the law, according to the nonpartisan Congressional Budget Office. Many of its provisions are focused on the 40 states that expanded Medicaid under the ACA, which added millions more low-income adults to the rolls. But the consequences are not confined to those states. A proposal from conservatives to cut more generous federal payments for people added to Medicaid by the ACA expansion didn’t make it into the law. “Politicians in non-expansion states should be furious about that,” said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank. The number of people losing coverage could accelerate in non-expansion states if enhanced federal subsidies for Obamacare plans expire at the end of the year, driving up premiums as early as January and adding to the rolls of uninsured. KFF estimates as many as 2.2 million people could become uninsured just in Florida, a state where lawmakers refused to expand Medicaid and, partly as a result, now leads the nation in ACA enrollment. For people like Francoise Cham of Miami, who has Obamacare coverage, the Republican policy changes could be life-altering. Before she had insurance, the 62-year-old single mom said she would donate blood just to get her cholesterol checked. Once a year, she’d splurge for a wellness exam at Planned Parenthood. She expects to make about $28,000 this year and currently pays about $100 a month for an ACA plan to cover herself and her daughter, and even that strains her budget. Cham choked up describing the “safety net” that health insurance has afforded her — and at the prospect of being unable to afford coverage if premiums spike at the end of the year. “Obamacare has been my lifesaver,” she said. If the enhanced ACA subsidies aren’t extended, “everyone will be hit hard,” said Cindy Mann, a health policy expert with Manatt Health, a consulting and legal firm, and a former deputy administrator for the Centers for Medicare & Medicaid Services. “But a state that hasn’t expanded Medicaid will have marketplace people enrolling at lower income levels,” she said. “So, a greater share of residents are reliant on the marketplace.” Though GOP lawmakers may try to cut Medicaid even more this year, for now the states that expanded Medicaid largely appear to have made a smart decision, while states that haven’t are facing similar financial pressures without any upside, said health policy experts and hospital industry observers. KFF Health News reached out to the governors of the 10 states that have not fully expanded Medicaid to see if the budget legislation made them regret that decision or made them more open to expansion. Spokespeople for Republican Gov. Henry McMaster of South Carolina and Republican Gov. Brian Kemp of Georgia did not indicate whether their states are considering Medicaid expansion. Brandon Charochak, a spokesperson for McMaster’s office, said South Carolina’s Medicaid program focuses on “low-income children and families and disabled individuals,” adding, “The state’s Medicaid program does not anticipate a large impact on the agency’s Medicaid population.” Enrollment in ACA marketplace plans nationwide has more than doubled since 2020 to 24.3 million. If enhanced subsidies expire, premiums for Obamacare coverage would rise by more than 75% on average, according to an analysis by KFF. Some insurers are already signaling they plan to charge more. The CBO estimates that allowing enhanced subsidies to expire will increase the number of people without health insurance by 4.2 million by 2034, compared with a permanent extension. That would come on top of the coverage losses caused by Trump’s budget law. “That is problematic and scary for us,” said Eric Boley, president of the Wyoming Hospital Association. He said his state, which did not expand Medicaid, has a relatively small population and hasn’t been the most attractive for insurance providers — few companies currently offer plans on the ACA exchange — and he worried any increase in the uninsured rate would “collapse the insurance market.” As the uninsured rate rises in non-expansion states and the budget law’s Medicaid cuts loom, lawmakers say state funds will not backfill the loss of federal dollars, including in states that have refused to expand Medicaid. Those states got slightly favorable treatment under the law, but it’s not enough, said Grace Hoge, press secretary for Kansas Gov. Laura Kelly, a Democrat who favors Medicaid expansion but who has been rebuffed by GOP state legislators. “Kansans’ ability to access affordable healthcare will be

Ahead of Intelligent Health (13-14 September 2023, Basel, Switzerland), we asked Yurii Kryvoborodov, Head of AI & Data Consulting, Unicsoft, his thoughts on the future of AI in healthcare.   Do you think the increased usage of Generative AI and LLMs will have a dramatic impact on the healthcare industry and, if so, how?   Generative AI is just a part of the disruptive impact of all AI tech on the healthcare industry. It allows to dramatically reduce time efforts, costs and chances of mistakes. Generative AI and LLMs are applied to automating clinical documentation, drug discovery, tailoring of treatment plans to individual patients, real-time clinical decision support and health monitoring, extracting valuable insights from unstructured clinical records, streamlining administrative tasks like billing and claims processing, providing instant access to comprehensive medical knowledge. And this list continues.

We sat with Benjamin von Deschwanden, Co-Founder and CPO at Acodis AG, to ask him his thoughts on the future of AI in healthcare.   Do you think the increased usage of Generative AI and LLMs will have a dramatic impact on the healthcare industry and, if so, how?   I think that the strength of Generative AI lies in making huge amounts of information accessible without needing to manually sift through the source material. Being able to quickly answer any questions is going to be transformative for everyone working with increasingly bigger data sets.The challenge will be to ensure that the information we get by means of Generative AI is correct and complete – especially in healthcare – as the consequences of wrong data can be fatal. We at Acodis are actively working on practical applications of Generative AI inside our Intelligent Document Processing (IDP) Platform for Life Science and Pharma clients to drive efficiency and accelerate time to market, whilst controlling the risks.

Intelligent Health 2024 returns to Basel, Switzerland on 11th–12th September. We’ve got prominent speakers. An extensive programme. Groundbreaking advancements in #HealthTech. And much, much more. Our incredible 2024 programme will dive deeper than ever before. From sharing the latest innovation insights to exploring use cases of AI application in clinical settings from around the world. All through our industry-renowned talks, limitless networking opportunities, and much-loved, hands-on workshops. Read on to discover what themes await at the world’s largest AI and healthcare summit. 

We sat down with Margrietha H. (Greet) Vink, Erasmus MC’s Director of Research Development Office and Smart Health Tech Center, to ask her for her thoughts on the future of AI in healthcare.   Do you think the increased usage of Generative AI and LLMs will have a dramatic impact on the healthcare industry and, if so, how?   The integration of Generative AI and LLMs into the healthcare industry holds the potential to revolutionise various aspects of patient care, from diagnostics and treatment to administrative tasks and drug development. However, this transformation will require careful consideration of ethical, legal, and practical challenges to ensure that the benefits are realised in a responsible and equitable manner.