Main Barriers to States Expanding Medicaid

Even though Medicaid coverage varies greatly from state to state, now under the Affordable Care Act’s option to expand the program, there are ways the public and private sectors can cooperate to provide care, Leah Binder said. Maternity care is a good example since Medicaid pays for half of the births in the United States and the other half are purchasers. But both sides are concerned about the rise in the rate of caesarean sections across the country.

“If we start aligning and working together on these issues, I think there can be some real progress,” she said. “And that’s regardless of the expansion. That can happen in any state.”

Meanwhile, Austin Frakt, PhD wondered how much the hesitation to expand Medicaid, which mostly occurred in red states, is a result of politicians waiting for a change in the administration. Matt Salo admitted that the top reason why states haven’t expanded the program is political, and pushback tends to come from the state house of representatives.

The second reason states haven’t expanded Medicaid is financial, and third is ideological. States are trying to figure out how to structure Medicaid expansion so that it makes sense for their residents. That’s why some states, such as Arkansas, Indiana, Iowa, and Michigan, have gone a different route with their expansion plans.

“How do you create a program that meets the ideological needs of people who think differently about healthcare?” Salo asked. “How do you engage the consumer in a different way than Medicaid traditionally has?”