The Universality of Medicaid at Fifty

17 Pages Posted: 24 Dec 2014

See all articles by Nicole Huberfeld

Nicole Huberfeld

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

Date Written: December 22, 2014


This essay, written for the Yale Law School symposium on The Law of Medicare and Medicaid at 50, explores how the law of Medicaid after the ACA creates a meaningful principle of universalism by shifting from fragmentation and exclusivity to universality and inclusivity. The universality principle provides a new trajectory for all of American health care, one that is not based on individual qualities that are unrelated to medical care but rather grounded in non-judgmental principles of unification and equalization (if not outright solidarity). This essay examines the ACA's legislative reformation, which led to universality, and its quantifiable effects. The essay then assesses and evaluates Medicaid’s new universality across four dimensions - governance, administration, equity, and eligibility. Each reveals a facet of universality that underscores this new principle’s importance for health care into the future.

Keywords: Medicaid, health care reform, fragmentation, universality, federalism, ACA, Affordable Care Act, Obamacare

Suggested Citation

Huberfeld, Nicole, The Universality of Medicaid at Fifty (December 22, 2014). Yale Journal of Health Policy, Law, and Ethics, Forthcoming, Available at SSRN:

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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