Scrutinizing Alternative Paths to Medicaid Expansion

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.