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Invited Commentary
October 2016

Scrutinizing Alternative Paths to Medicaid Expansion

Author Affiliations
  • 1Center for State Health Policy, Rutgers University, New Brunswick, New Jersey
  • 2School of Public Affairs and Administration, Rutgers University, Newark, New Jersey
  • 3Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey
JAMA Intern Med. 2016;176(10):1510-1511. doi:10.1001/jamainternmed.2016.4422

We applaud the work of Sommers and colleagues1 in this issue to gauge the implications of different types of Medicaid expansions for pertinent measures of medical care access and quality as well as health. Their analysis clearly indicates that expanding Medicaid, whether through the Kentucky or Arkansas approaches, brings demonstrable benefits for previously uninsured low-income individuals. Their findings that outcomes in Arkansas, a private-option expansion state, did not differ appreciably from Kentucky, with a traditional Medicaid expansion, are also important. As the authors note,1 their results intersect with ongoing discussions as to whether federal flexibility in approving alternative state approaches to the expansion has positive or negative implications. The authors1 also aptly observe that Arkansas represents only 1 variant of these diverse approaches. In this commentary, we provide some backdrop on state variations more generally and the importance of continued close scrutiny to assess the implications of alternative paths to Medicaid expansion.

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