The GOP proposal would represent a massive money shift from one group of states to another. Roughly two-thirds of the states would see a combined loss of more than a $250 billion between 2020 and 2026, according to the Kaiser analysis. At the same time, a third of the states would pick up nearly $70 billion in new funding during that four-year period.



The biggest losers by far would be California and New York, which would lose a combined $114 billion over four years, roughly half the total cuts. Both are heavily Democratic states that opted to expand Medicaid coverage under the Affordable Care Act.



The biggest winner could be Texas, a Republican state that did not expand Medicaid coverage, which would pick up more than $28 billion in new funding under the Graham Cassidy bill. The remaining funding gainers, including Georgia, Alabama, Mississippi, Tennessee, South Carolina, Missouri and Wisconsin, are largely red states.



The realignment would be generated by several provisions in the proposal, including a shift in funding from the current Medicaid reimbursement formula to a set of fixed block grants. The bill also caps the amount of federal Medicaid funding for the states and eliminates funding provided under the Affordable Care Act.



It remains to be seen whether the proposal can capture the 51 votes needed to win approval in the Senate. Democrats are uniformly opposed and a handful of GOP senators have expressed reservations about the bill.