All states lose under Graham-Cassidy, the latest Republican attempt to repeal the Affordable Care Act. The new TrumpCare bill replaces Medicaid expansion with an inadequate block grant and imposes drastic cuts on traditional Medicaid through arbitrary caps. And by eliminating Medicaid expansion, the bill denies states that have not expanded Medicaid the option of expanding after 2020.

What is striking, however, is how much non-expansion states – that is, states that have not yet expanded Medicaid as permitted under the ACA – lose under Graham-Cassidy. Non-expansion states will receive less Medicaid funding, even taking into account the short-term funding, than if they expanded Medicaid. Denying non-expansion states the opportunity to expand Medicaid forces them to leave $37 billion each year in federal funding on the table, totaling $258 billion between 2020 and 2026, compared to the Medicaid funding they would receive under Graham-Cassidy. In 2027 and beyond, these non-expansion states would lose even more funding as they lose all short-term block grant funding and face arbitrary caps to traditional Medicaid.

There are no winners under Graham-Cassidy. This bill takes away states’ flexibility to expand Medicaid and strips their opportunity to receive federal funds to expand coverage and bring down health care costs for their people.