KFF's new analysis estimates $60 billion in federal Medicaid spending in 37 states (including DC) would likely exceed new federal limits on state directed payments for hospital services once implemented. More than half of the potential reductions could come from 8 states.

ACA Marketplace enrollment fell this year in every state except New Mexico—the only state to fully replace the enhanced premium tax credits that expired last year with a state-funded subsidy, according to a new KFF analysis of effectuated enrollment data. The Marketplace enrollment decline—the first in seven years—follows several years of rapid enrollment growth and coincides with the end of the enhanced federal subsidies.