Essentials of Health Policy and Law 2nd Edition by Joel Teitelbaum,Sara Wilensky

Exercise 13

Looking at Medicaid's traditional eligibility rules, you notice numerous value/policy judgments-pregnant women and children are favored over childless adults, the medically needy are favored over other low-income individuals with high costs, non-immigrants are favored over immigrants. Under the ACA expansion, these distinctions mostly disappear and eligibility depends purely on income level in the case of the biggest expansion group. Which approach do you prefer? If the ACA approach were expanded beyond 133% of FPL, the costs of the Medicaid program would soar. Given limited resources, do you think it would be better to cover more people at a higher poverty level across the board or continue to favor some groups over others through the categorical requirement? Should we decide that, for some populations, the government should step in and provide coverage regardless of the cost? In other words, is there a point where equity trumps financial constraints?