State Lawmaker’s Guide to Evaluating Medicaid Expansion Projects

In its opinion on the Obamacare case, the Supreme Court found Congress exceeded its Constitutional authority by conditioning existing Medicaid funding on state adoption of the Medicaid expansion in Obamacare. The ruling effectively made the expansion optional. Supporters of Obamacare, as well as some health care stakeholders—particularly hospitals and clinics—have since contended that states should voluntarily adopt Obamacare’s Medicaid expansion. They claim that expanding Medicaid will entail little to no cost to state governments, since the federal government will fund the vast majority of the additional costs. Indeed, some analyses project states achieving savings from adopting the expansion. However, state lawmakers should be wary of accepting such analyses at face value.

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