Medicaid Expansion as Completion of the Great Society

Abstract

A state’s decision whether to expand Medicaid has become a highly politicized issue, spawning countless news stories and on-going debate. However, this Essay takes a step back from that highly charged discourse and situates Medicaid expansion in its historical context. We reveal that this latest change universalizes the program, holding the power to finally realize President Johnson’s vision for the Great Society, almost fifty years later. Medicaid can be understood as a universal program for three reasons: (1) the percentage of the population of children, pregnant women, and non-elderly adults it covers; (2) the degree to which Medicaid funds long-term care for the elderly and the disabled, and (3) the ACA’s philosophy that makes Medicaid a universal safety net, one that covers not just the deserving poor, but anyone who cannot afford health insurance. This new perspective on the Medicaid expansion is particularly timely and salient in light of this fall’s upcoming gubernatorial elections. It reveals that Medicaid is more than a political issue: It is a matter of civil rights.

Keywords: Medicaid, Medicaid expansion, health-care reform, Affordable Care Act, civil rights, universal vulnerability, Great Society