ACA and the Perils of Federal-State Partnerships

When it comes to public benefit programs, federal-state partnerships often disappoint. States once determined eligibility for food stamps, and access to the program was not available in many counties across the country. And because states have set the income thresholds for adults to qualify for Medicaid, access to health care coverage has varied considerably from state-to-state for the indigent.

Unfortunately, both because of ACA’s design and the Supreme Court’s decision on the Medicaid expansion, ACA’s implementation relies quite a bit on federal-state partnerships. We are now seeing substantial differences from state to state in the roll out of the statute. As the Wall Street Journal reported earlier this week and the New York Times earlier this month, poor people are much more likely to obtain Medicaid coverage in New Mexico than next door in Texas, and customers for insurance on an ACA exchange will find much more guidance from state officials in Colorado than in Missouri.

The Medicare model of a federal-only program works much more effectively at delivering its benefits than does the Medicaid/ACA model of a federal-state partnership.