Dynamic Expansion

11 Pages Posted: 24 Nov 2013

See all articles by Nicole Huberfeld

Nicole Huberfeld

Boston University School of Law; Boston University - School of Public Health

Date Written: November 22, 2013


In the run up to the ACA’s effective date of January 1, 2014, the sleeper issue has been the Medicaid expansion, even though Medicaid stands to cover nearly a quarter of the United States citizenry. While the national press has portrayed a bleak picture that only half of the states will participate, the Medicaid expansion is progressing apace. Though this thesis may sound wildly optimistic, it is more than predictive; it is empirically based. I have gathered data on the implementation of the Medicaid expansion during the crucial months leading up to the operation of the insurance provisions of the ACA, and it is clear that most states are moving toward expansion, even if they are currently classified by the media as “not participating” or “leaning toward not participating.” The data thus far reveals counterintuitive trends, for example that many Republican governors are leading their states toward implementation, even in the face of reticent legislatures and a national party’s hostility toward the law. Further, the data demonstrates dynamic negotiations occurring within states and between the federal and state governments, which indicates that the vision of state sovereignty projected by the Court in NFIB v. Sebelius was incorrect and unnecessary.

Keywords: health reform, Medicaid, federalism, ACA, expansion, NFIB

Suggested Citation

Huberfeld, Nicole, Dynamic Expansion (November 22, 2013). Available at SSRN: https://ssrn.com/abstract=2358641 or http://dx.doi.org/10.2139/ssrn.2358641

Nicole Huberfeld (Contact Author)

Boston University School of Law ( email )

765 Commonwealth Avenue
Boston, MA 02215
United States

Boston University - School of Public Health ( email )

715 Albany Street
Boston, MA 02118
United States

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