In 2018, the Trump Administration and GOP made several attempts to repeal the ACA and impose federal spending caps on the Medicaid program to reduce costs. These efforts were ultimately unsuccessful; however, a handful of states expanded their Medicaid programs

Over the last three years, the Coronavirus public health emergency was extended several times. The PHE and the Families First Coronavirus Response Act altered Medicaid eligibility, and as a result, Medicaid enrollment surged during the pandemic. Between February 2020 and