Federalize Medicaid to Fix the Affordable Care Act: For Efficiency, Equity, and Social Justice

Federalizing Medicaid (thereby eliminating state program variation) is a bold and affordable alternative to Medicare for all (M4A) and proposed ACA public options. Making Medicaid an entirely federal program using Congress' budget reconciliation process will reverse the U.S. Supreme Court ruling that enabled states to reject Medicaid expansion. Such legislation achieves Congress' original intention to create universal entitlements for low-income persons who lack health coverage and concentrate new federal health spending on them (unlike M4A). Arguments for federalizing Medicaid involve state budget relief, efficiency, social justice and the history that created national industries from local and state-based health systems. Theory suggests that liberal democracies are generally more successful when path dependent, building incrementally on existing policies instead of plunging into new, untested innovations no matter how rational. In addition to realizing the congressional intent of the ACA, federalizing Medicaid can be a cost-effective, incremental path to single-payer health coverage.