As it stands now, the government pays a private insurance company for your healthcare if you are on medicaid. Private health insurance companies are therefore growing from expanded medicaid programs. Many are increasing profits at higher rates than expected. This is allowing big insurance companies to buy out smaller companies, and this is where your choice in plans will decrease. Forbes reported that five insurance companies are reaping huge financial rewards from the Affordable Care Act, as they are getting money allocated for healthcare through Medicaid. It will become easier for the big five to deny coverage for a drug or treatment and patients will not be able to find another choice in coverage that does cover a needed benefit. This means the likelihood that appealing healthcare denials will be the only recourse. I wrote an article, not too long ago, on how this process thwarts patient care, and why this is not a great solution to coverage denials.