HEALTH REFORM: Key Factors That May Influence a State's Decision on Whether to Expand Its Medicaid Population Under the Affordable Care Act


Speculation abounds with respect to the decision that states will make on the issue of whether to expand Medicaid coverage under the Affordable Care Act (“ACA”), now that the Supreme Court of the United States (the “Court”) has made the option to abstain a meaningful one. This health reform alert highlights some key factors that may influence a state’s decision on whether to implement such an expansion.

In order to expand health coverage and make some attempts at reducing health care costs, the ACA implements a myriad of provisions that increase the federal government’s role in the health care delivery and health insurance benefits sectors—historically, the purview of mostly state regulation. One provision recently subjected to constitutional scrutiny includes the individual mandate for private citizens to purchase or obtain health benefits coverage or face a penalty. The Court also reviewed a provision containing the criteria for expanding Medicaid coverage to new eligibles in the states. This health reform alert focuses on the impact of the Court’s decision on the latter issue, i.e., Medicaid expansion. The ACA was opposed by 26 states before the Court, and the Republican-led House of Representatives has voted to repeal or defund the law 31 times. Statistics such as these disclose the high level of resistance to adoption of the ACA. Consequently, it is not surprising that states are seriously weighing the Medicaid expansion option.

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