The Medicaid Expansion Promise

At WaPo’s Wonkblog today, Jason Millman cites a prominent study to knock down one of the first and most abiding Republican arguments in states that have rejected the Affordable Care Act’s Medicaid expansion: the generous federal match rate reflects a promise liberals do not intend to keep. There’s certainly no historic support for that assertion:

[B]ased on the 49-year history of the Medicaid program, that claim doesn’t hold up, according to Urban Institute researchers in a finding that hasn’t received as much attention….

Urban researchers found that of the 100-plus cuts the federal government has actually made to the Medicaid program since 1980, lawmakers just once reduced the federal share of Medicaid financing — and that was in 1981. Other federal cuts have been to services, payments to providers, or in program eligibility.

It should be mentioned that the 1981 match-rate cut (technically, a reduction in federal reimbursement for a limited period of time, not an actual change in the underlying match) was at the insistence not of deceptive liberals but of the sainted Ronald Reagan. Indeed, liberals, led by Henry Waxman, engineered a long series of “super-matches”–increases in the federal match rate for Medicaid coverage of specific services or populations–during the 1980s and 1990s.

The big thing to remember here is that liberals want expanded Medicaid coverage, and are willing to pay for it at the federal level. The whole bait-and-switch meme behind Republican resistance to the expansion at the state level lacks logical as well as historical support.

Washington Monthly - Donate today and your gift will be doubled!

Support Nonprofit Journalism

If you enjoyed this article, consider making a donation to help us produce more like it. The Washington Monthly was founded in 1969 to tell the stories of how government really works—and how to make it work better. Fifty years later, the need for incisive analysis and new, progressive policy ideas is clearer than ever. As a nonprofit, we rely on support from readers like you.

Yes, I’ll make a donation

Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.