Medicaid Transformed: Why ACA Opponents Should Keep Expanded Medicaid

The next potential disaster facing the Affordable Care Act (ACA) is the November 2012 elections: Its opponents, who promise to “repeal and replace,” may gain sufficient control of the federal government in 2013 to carry out their pledge. This commentary aims to promote understanding of the fundamental transformation that the ACA makes in Medicaid and to urge ACA opponents desiring some health reform after repeal to let the ACA’s Medicaid provisions stand. After an introduction to the ACA and its vulnerabilities the commentary examines the evolution of Medicaid since its 1965 origins as a means-tested concomitant of cash welfare. It shows that Medicaid has been very adaptable as it morphed into a complex categorical program for specific populations or types of care. The ACA transforms Medicaid into a universal means-tested entitlement for anyone below 138 percent FPL. The conclusion explains why ACA opponents should retain its Medicaid provisions.