Medicaid Expansion….pro and con

Florida is at the center of the Medicaid Expansion debate. The Affordable Care Act greatly expanded the criteria that would allow individuals to qualify for Medicaid (a federal/state program of providing health insurance to poor and nursing home patients.)  Although the federal government picked up the lions share of the cost, states would have to assume some of the expense.  This led to debate and courts challenges.  The supreme court finally ruled that the federal government could not force the expansion on the states and the expansion was optional.

Florida has decided to opt out of the expansion. This decided is applauded and derided by various groups.  The challenge is deciding what are the facts free of the rhetoric.

Dr. Aaron Carol and Dr. Austin Frakt did a succinct analysis of the pros and cons.  Below is a small excerpt from their blog but I suggest you check out the complete post at:


  • State elected officials are politically constrained in their choices. Antos is quite explicit on this (“If you choose the latter [Medicaid expansion in your state] you stand a good chance of being thrown out of office the next election.”) We discuss politics at the end of our paper, concluding that it is not our job to look after the political fortunes of state officials. That they will (or won’t) expand Medicaid and that they should (or should not) are separate matters.
  • Expanding Medicaid is not free for the states. Reading Antos’s paper you might think we dispute that, but we don’t.
  • Antos makes a direct appeal to the virtue of choice. We don’t take that up in our paper, but we do not dispute that there is value in choice.
  • The Medicaid expansion was a lower cost means of increasing coverage. Antos and we acknowledge that private coverage costs more, as would increasing Medicaid payment rates to providers.
  • States may be able to use the Medicaid expansion as a bargaining chip, to extract favorable waivers from the Center for Medicare and Medicaid Services (CMS). We wrote that, and Antos seems to agree. We also probably all agree that this is among the most important unsettled areas to watch in terms of health policy.