Health Care for All: An Overview of the Affordable Care Act’s Medicaid Expansion in the USA

Published date01 June 2018
Date01 June 2018
DOI10.1177/0019556117750895
Subject MatterArticles
Article
Indian Journal of Public
Administration
64(2) 174–192
© 2018 IIPA
SAGE Publications
sagepub.in/home.nav
DOI: 10.1177/0019556117750895
http://journals.sagepub.com/home/ipa
1 School of Economic, Political and Policy Sciences, The University of Texas at Dallas, Texas, USA.
Corresponding author:
Meghna Sabharwal, The University of Texas at Dallas, 800 W. Campbell Rd, GR31Richardson, TX
75080, USA.
E-mail: meghna.sabharwal@utdallas.edu
Health Care for All:
An Overview of the
Affordable Care Act’s
Medicaid Expansion in
the USA
Ariel Arguelles1
Meghna Sabharwal1
Abstract
One of the most significant health care reforms since the implementation of
Medicare and Medicaid, the Affordable Care Act (ACA) enacted into law in 2010,
was met with widespread criticism. The expansion of Medicaid eligibility was a
specific focus of these critiques as sceptics believed the long-term effects would
be primarily negative for both the physical and fiscal health of the population.
This article provides a brief history of the ACA along with the role of political
and public opinion. This is followed with an analysis of initial criticisms and
concerns surrounding the eligibility and expansion—with a brief discussion of the
constitutionality of the law. Finally, while the long-term effects of the ACA upon
health care access and service in the USA are yet to be seen, preliminary results
indicate positive effects, contrary to the negatives originally assumed. The article
concludes with a summary of current health care reform and a prospective on
the future of health care reform in the USA.
Keywords
Affordable Care Act, Medicaid, social welfare, public opinion, US health care
reform
Arguelles and Sabharwal 175
Introduction
Considered to be one of the most important pieces of health care legislations since
the development of Medicaid and Medicare in 1965, the Patient Protection and
Affordable Care Act (ACA) was signed into law on 23 March 2010 (Paradise,
2015), transforming how health care was practiced, how legislation was imple-
mented, and how individuals received medical care. Like many presidents before
him (Morone, 2010), President Barack Obama made health care reform a major
platform for his campaign and for many scholars, the ACA stands as the magnum
opus of his presidential legacy (Potorazu, 2016). However, the development and
implementation of the ACA was filled with controversy and extreme political and
public backlash, eventually leading to three Supreme Court cases (Musumeci,
2012).
The arguments of the benefits, negatives and problems associated with the
Medicaid expansions were only a part of the serious issues that many physicians,
policymakers and patients had with the ideology and implementation of the ACA.
Some of the arguments that opponents used typically focused on opposition the
individual mandate, the potential of rising tax burdens on the public, and the over-
reach of federal power on state rights and choices (ibid.). However, the criticisms
and concerns of what the Medicaid expansions meant to both policymakers and
the public, from an economic and social perspective, are the primary focus of this
article. Additionally, the role of public opinion was a significant contributor to
the reception and implementation of the ACA. While policymakers had multiple
concerns surrounding the legislation, public perception of the ACA has remained
primarily negative until recently (Fingerhut, 2017).
This article is divided into three parts: first, a brief history of the ACA and
the role of political and public opinion on its development is explored specifi-
cally focusing on the political and legislative fight against the expansion of
Medicaid coverage; second, an in-depth analysis of what the original expansions
to Medicaid would have entailed is evaluated along with the initial criticisms and
concerns which ultimately led to the Supreme Court case and ruling; And finally,
while the long-term effects of the ACA upon health care access and service in the
USA are yet to be seen, preliminary analysis of how the Medicaid expansions—or
lack thereof—have affected health outcomes is explored. The article concludes
with a summary of current health law proposals and a prospective on the future of
health care reform in the USA.
Brief Overview of Health Care Reform
Health Care Policy in the Pre-modern Era
The history of health care legislation within the USA is fraught with political
infighting, public backlash and begrudging acceptance as seen through the fight
against Managed Care in the early 1970s (Mechanic, 2004), the failed Clinton
health care bill of 1993 (Webber, 1995) and the many debates surrounding health
care reform during President George W. Bush’s second term (Carroll, 2007;

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