A national map shows it clearly: the future expansion of the four year-old Patient Protection and Affordable Care Act – widely known as Obamacare – remains at the discretion of individual states, and its coast-to-coast implementation is far from a sure thing.
Catholic University’s Journal of Contemporary Health Law and Policy presented a forum on the issue on April 10th. The “2014 Symposium on Expanding Medicaid: A Cross-State Comparative Analysis” invited expert prognostications on where the controversial law is headed.
In 2012, the United States Supreme Court upheld the constitutionality of the ACA's individual mandate, but it also held that states cannot be forced to participate in the ACA's Medicaid expansion under penalty of losing their current Medicaid funding.
A number of states have declined to implement the ACA at all, even as legal challenges to it continues from some state governments, conservative advocacy groups, unions, and small business organizations.
The first panel’s presenter was Laura Snyder, a policy analyst with the Kaiser Commission on Medicaid and the Uninsured. She walked the audience through the patchwork quilt of the law’s implementation at the state level so far.
Some states have adopted law’s expansion of Medicaid wholly and completely, others are in the process, while a third group of states, many of them in the south, have essentially ignored it.
“The decision of each state matters significantly,” Snyder explained. “This is a fluid situation. We’ll be watching to see what each state does as we move forward.”
The ACA was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government.
Opponents consider the law coercive, unaffordable, and an unwarranted expansion of federal power into states’ prerogatives.
“It’s going to take a little bit of time,” said Snyder, referring to the ACA’s gradual acceptance so far. “It’s going to take a change in the politics of some states.”
The afternoon’s second panel considered competing policy considerations that have also affected the adoption of the ACA’s Medicaid expansion goals. Panelists included Thomas Miller, resident fellow with the American Enterprise Institute, and Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University.
Welcome remarks were offered by Brian Farnkoff, editor-in-chief of Volume XXX of the health law journal, and Daniel Attridge, dean and Knights of Columbus Professor at the law school.