by Jason D. Fodeman
James Madison Institute
March 20, 2014
Policy Brief
Health care reform as signed into law would have forced each state to adopt the Medicaid expansion or forfeit all federal Medicaid support. The Supreme Court declared this unconstitutionally coercive, essentially making the expansion optional. As Florida debates whether to expand eligibility for Medicaid to persons with incomes up to 138 percent of the federal poverty level, legislators must remember that the state already struggles to fund its current Medicaid program. As Medicaid’s costs explode, a rigid federal statute leaves states’ policymakers with few options to control costs other than by paying Medicaid providers less and less. In turn, these dismal reimbursements jeopardize the access of Medicaid patients to high-quality care. Expansion will not fix the pervasive flaws of the Medicaid program; rather, it will merely subject more people to these problems. Instead, policymakers should take this opportunity to improve access to higher-quality care for the under and un-insured.

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