Expanding Medicaid: Conflicting Incentives

The decision facing individual states is complex. Setting aside the larger question of whether the ACA’s ambitious coverage expansion is good national policy, several competing factors now bear upon the states’ incentives. These include individual state budget circumstances, the 2012 Supreme Court decision, federal Medicaid financing support levels, the federal government’s own fiscal problems, and interactions between Medicaid and the ACA’s new health exchanges.