Must-Read: Ann Marie Marciarille: The Medicaid Gamble
Must-Read: Ann Marie Marciarille (2014): The Medicaid Gamble: “The Patient Protection and Affordable Care Act (ACA)1 was an unprecedented gamble…
…transform[ing] Medicaid from an unevenly and underfunded program for the poor and disabled to a program to offer those priced out of commercial insurance markets government-funded health insurance similar to Medicare…. The ACA gambled that Medicaid could be more like Medicare…. [This,] the first Medicaid gamble was the one the legislative majorities that passed the ACA intended to make…. That gamble is going forward in the early-adopter states….
Overlaid… is a second Medicaid gamble… states like California… Medicaid can be turned into something like Medicare without raising provider reimbursement rates to something like Medicare levels…. A third Medicaid gamble… that previous Supreme Court worries about federal coercion of states did not raise the possibility that the Court might disallow nationwide Medicaid expansion….
The fourth Medicaid gamble was that of United States Supreme Court Chief Justice John Roberts: that bending the arc of history away from long-run government expansion is best accomplished not by risking the Supreme Court’s moral authority via a declaration that the ACA’s individual mandate was unconstitutional, but rather by putting the Court’s thumb on the scales so that states could bargain with the federal government about how, and when, and if, the ACA were to be implemented…. The fifth Medicaid gamble was… the apparent gamble of Justices Kagan and Breyer that a functional judicial rewriting-on-the-fly of the ACA statute would not break the mechanism….
And then there are the various state level Medicaid gambles: Arkansas’s and others’… that the federal government will hold states harmless if they pursue high-cost Medicaid expansion paths; other states gamble that their hospitals, doctors, and citizens can flourish without Medicaid expansion; and still other states gamble that by delaying Medicaid expansion they can negotiate better terms for themselves…