The Supreme Court’s decision last week on the constitutionality of the Affordable Care Act (ACA) has been acclaimed as a victory for health care reform, as well as for President Obama. A critical part of the decision, however, goes to the heart of the ACA’s promise of near-universal coverage. The law set vital new conditions on the receipt of federal funding for Medicaid: it requires states to expand their eligibility rules to cover all people with incomes less than 133% of the federal poverty level, and if they decline to do so, they could lose not only federal funding for the Medicaid expansion but also federal funding for existing state Medicaid programs.
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