The Medicaid Platform

The expanded role of Medicaid is vulnerable to three unseen factors: the politics of insurance payments; the commitment and capacity of individual states; and, the willingness of the federal government to share costs (also called compensatory federalism).

Under the Patient Protection and Affordable Care Act (ACA), Medicaid will expand to cover more than 30 million currently uninsured individuals. While there are expected political and legislative challenges to the new law, this article exposes conditions that may have already weakened Medicaid’s structural foundation.

Frank J. Thompson of Rutgers University takes up the idea that factors “invisible at the surface,” or “implementation termites,” can corrode social policy—Medicaid in this case.

Key Findings:

  • Because of low reimbursement rates, many physicians decline participating in Medicaid; ACA requires states to bring Medicaid payment rates up to the levels prevailing in Medicare.
  • States are not equally committed to Medicaid; in Florida and Texas, among children who qualify, 30 and 29 percent are uninsured.

“Implementation termites” are counterproductive factors hidden in the structure of social policy. In this article Frank J. Thompson discusses three factors specific to Medicaid. While many are optimistic about Medicaid’s strength, Thompson alerts the reader to the program’s “termites.”