Medicaid expansion appears to be following the same trajectory as the original program that was created in 1966, with about half of the states joining the expansion effort quickly and the rest gripped in a highly politicized struggle.
If history repeats itself, the battle over Medicaid expansion could be grueling campaigns in some states. Arizona resisted joining the Medicaid program until 1982.
But a handful of states, including Arkansas and New Hampshire have apparently found a way to break the political impasse: using federal Medicaid expansion dollars to fund the expansion of Medicaid through the new public health insurance exchange for individuals. And Missouri is fully engaged in an effort to move legislation forward.
"This is definitely the playbook states are using," says Brendan Saloner, PhD, lead author of a perspective piece on Medicaid expansion published in the New England Journal of Medicine on March 27. In a phone interview last week, he said, "there is a certain toxicity to the [Patient Protection and Affordable Care Act] that makes it hard to make progress."