As enacted, the ACA required states to expand their Medicaid programs to include adults with incomes of 133 percent of the federal poverty level or else lose all funding for their states’ Medicaid programs — a multi-billion dollar penalty that would have eviscerated many states’ Medicaid plans. When the issue reached the United States Supreme Court in 2012, the majority opinion called the requirement an unconstitutional “gun to the head” of the states and threw it out. Medicaid needs to be reformed, not expanded with debt-addled Washington spending. Free market ideas can take us in a better direction.

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About the Author

Patrick Ishmael
Director of Government Accountability

Patrick Ishmael is the director of government accountability at the Show-Me Institute.