Health Care Reform in the U.S. and the Transformation of Medicaid

Background.  The U.S. enacted the Patient Protection and Affordable Care Act of 2010 (ACA, P.L. 111-148/152) after a struggle lasting 100 years.  The health reform effort has been under constant attack during Congressional deliberations and after enactment; the outcome of efforts to terminate it have yet to be determined.

This peculiarly American solution to achieve near universal coverage continues the fragmented coverage and delivery systems that generate the world’s most costly health care.  A major part of this coverage mix is Medicaid, the income-tested program for (some of) the poor.

The research focuses on changes in Medicaid generated by health reform.  Understanding the changes requires a brief examination of the remarkable evolution of Medicaid since it was established in 1965.  Methods and data involve analysis of published secondary materials, the texts of P.L. 111-148 and P.L. 111-152, and regulations relating to health reform issued by the executive branch.

The results show that the ACA will transform Medicaid in fundamental ways.  It creates a new right to health coverage for low-income Americans.  Part of the analysis involves listing the major current weaknesses of Medicaid and examining the ACA to determine whether the ACA when (if) fully implemented will overcome Medicaid’s shortcomings.

The concluding discussion will review the various threats to the ACA and assess their effects on the impending changes in Medicaid that ACA promises.