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In May 2017, the US House of Representatives narrowly approved — by a 217-to-213 vote — the American Health Care Act of 2017 (AHCA). This bill, which did not advance beyond the House, would have reversed California’s progress in extending health coverage to millions of people under the framework of the federal Affordable Care Act (ACA), which President Obama signed into law in 2010. California’s House delegation split along partisan lines: All 14 Republicans voted for the AHCA, while all 39 Democrats voted against it. Key provisions of the bill targeted Medicaid, which is known as Medi-Cal in California and covers over 13 million Californians with low and moderate incomes. The AHCA would have 1) phased out the expansion of Medicaid eligibility to certain low-income adults ages 19 to 64, including adults without dependent children, and 2) capped annual federal funding for the entire Medicaid program. Overall, the House bill would have shifted nearly $6 billion in costs for Medi-Cal from the federal government to California in 2020, rising to an annual shift of $24 billion by 2027, according to state projections. Such a massive cost-shift would have forced deep state spending cuts and put at risk the health and economic security of millions of Californians. Proposals to cut federal Medicaid funding and roll back other key provisions of the ACA could re-emerge in 2019 depending on the outcome of the upcoming midterm elections.