The major funding reductions planned for Medicaid would not only eliminate insurance coverage for millions, they would also hinder the ACA’s efforts to transform Medicaid into a more efficient health care purchaser, according to a Commonwealth Fund analysis by George Washington University’s Sara Rosenbaum and colleagues. Although not all states have expanded Medicaid eligibility, virtually all have embraced Medicaid accountable care organizations, adopted comprehensive managed care programs or health homes, or introduced some type of payment reform.