The Inexorable Expansion of Medicaid Expansion

Medicaid expansion to non-elderly adults under the Affordable Care Act (ACA) has come a long way since the U.S. Supreme Court made it optional in its landmark 2012 NFIB vs. Sebelius ruling, and 2018, in particular, was a banner year. In 2018 four states expanded Medicaid, three of them "red states" doing so by voter ballot. Expansion-favoring Democrats were also elected to replace expansion-opposing Republican governors. Strikingly, this success came just a year after Medicaid expansion, and the ACA as a whole, was only saved by a single U.S. Senate vote.

This article examines the early pushback by states against Medicaid expansion, and the eventual evolution into acceptance by many states, dating from the 2012 Court decision through 2017. It then assesses the Medicaid expansion success in 2018 and what that portends for the Medicaid program. Finally, it highlights key challenges that lie ahead.