By NextBestFitState & local government budgets
The net effect on state and local governments, combining health spending, new income-tax revenue, and lost premium taxes.
Result
$146.8B
Per resident, per year
$430
÷ 341.1M people
Per household
$1,111
÷ 132.2M households
How it's calculated
| # | Step | Arithmetic | Value |
|---|---|---|---|
| 1 | State & local health spending, 2024 Sources: CMS Office of the Actuary (2025) | $859.6B | |
| 2 | State & local health spending under the plan | $713.3B | |
| 3 | Health spending saved | $859.6B − $713.3B | $146.3B |
| 4 | Plus state income tax on newly taxable wages | $18.5B | |
| 5 | Minus state premium taxes lost | −$18.0B | |
| 6 | Net gain to state & local budgets | $146.8B |
Inputs used
| Input | Kind | Value |
|---|---|---|
| State premium taxes paid by health insurers | estimate, low confidence | $18.0B |
Trade-off: States gain money but lose control of Medicaid; high-Medicaid-spending states pay more MOE per resident than low-spending states.