Health Affairs June 23, 2021
Since the Affordable Care Act (ACA) Medicaid expansion launched in 2014, progress toward full adoption in the states has been slow. Seven years following implementation of enhanced funding, half of the 26 states that had not expanded in January 2014 have since joined. States’ initial adoption of Medicaid happened much more quickly: By 1972, similarly seven years after Medicaid was enacted, all states but one had joined the program.
Some observers predict that eventually the remaining states will probably adopt expansion. However, there are strong reasons to doubt that expansion in all states is inevitable or even likely. Recent Medicaid expansions have been accomplished primarily through voter-driven initiatives that have placed the issue on the ballot through signature drives. But...
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