Public budgets

90% federal match for expansion adults Official data

Washington pays 90% of costs for expansion adults. Texas's regular match for fiscal 2027 is 58.54%.¹ The extra federal bonus once offered to newly expanding states was repealed starting January 1, 2026.²

No measurable squeeze on other state spending (so far) Association

Studies of expansion states found large increases in federal Medicaid funds and no significant rise in state-funded spending or cuts to education.^3,4

Limits: Much of that period had a higher federal match than today.

Texas cost estimates are dated Projection

In 2013, the Legislative Budget Board estimated about $4.0 billion in state general revenue over 10 years. In 2020, analyses commissioned by a foundation that supports expansion estimated a state share of about $600–650 million a year before offsets, largely offset by savings and revenue.^5,6

Limits: Both estimates predate the 2025 federal law and the post-pandemic unwinding. No current official Texas estimate exists.

Local safety nets cover very few people Official data

County indigent care must cover residents only up to 21% of poverty (counties may choose up to 50%).⁷ The state's uncompensated-care pool is projected to shrink to about $3.1 billion a year by 2028–2030.⁸

Limits: Some county and hospital savings are plausible, but no current Texas estimate exists.

Coverage raises total spending Strong design

In Oregon, coverage increased medical spending by about $1,172 per person per year (about 35%).⁹ Prevention and early treatment are often worth their cost, but most preventive services do not save money overall.¹⁰