A centerpiece of the ACA is expansion of Medicaid – the health-insurance system for low-income and disabled Americans – which would have insured some 17 million additional people if implemented as originally envisioned. But in upholding the ACA, the Supreme Court allowed states to opt out of the Medicaid expansion without penalty; so far at least six Republican-led states, including Texas and Florida, have chosen not to expand their states' programs.
Romney proposes turning the federal portion of Medicaid funding into block grants, or lump-sum payments. Annual growth would be capped at the rate of inflation plus 1 percent. Democrats say that given high inflation in health care, the Romney plan would underfund the program, forcing states to cut people from the Medicaid rolls and/or reduce services.