For this discussion you are a nurse/staffer for the federal secretary of Health and Human Services. The secretary discusses with you the different ways that states have responded to the Medicaid expansion in the Affordable Care Act: Many states have adopted the expansion without much debate or negotiation, a few states, such as Arkansas, have negotiated special terms for their expanded programs (and are using Medicaid funding to buy private coverage for beneficiaries), and still other states, such as Texas, have simply refused to adopt the expansion. Your assignment is to prepare the secretary for her upcoming visit to Texas (and her meetings with the governor, the Medicaid director, and key interested group leaders) by writing a “memorandum” summarizing the political and policy dynamics of the proposed Medicaid expansion in Texas. Your “memo” should elaborate upon at least one of the following questions: Are the political reasons for not supporting Medicaid related to ideology about the role of government in health care, or are they more about potential long-run costs for the state budget? How do the interests of hospitals, which would benefit from the extra revenue if Medicaid expands, affect the political and policy debates? What is the role of public opinion in the choices being made by governors regarding this type of social issue/problem? Will states feel differently about this issue over time and if the new insurance law seems to become a permanent fixture in public policy?
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