Under the Affordable Care Act, what option did states have regarding Medicaid expansion?

Under the Affordable Care Act, what option did states have regarding Medicaid expansion?

• A. Eliminate Medicaid in all states.
• B. Expand Medicaid eligibility to 133% of the federal poverty level.
• C. Require private insurance for all residents regardless of income.
• D. Cease all health insurance exchanges.

Answer: (B)

The policy idea being tested is that the Affordable Care Act gave states the option to expand Medicaid to cover more low‑income adults by raising eligibility to 133% of the federal poverty level. This expansion was voluntary for states after the Supreme Court ruling, with the federal government covering the vast majority of the costs—initially 100% of the expansion and eventually about 90%. That combination—an expanded eligibility threshold and strong federal funding—made expansion a feasible choice for many states. The other options don’t reflect what the ACA implemented: it didn’t eliminate Medicaid, it didn’t require private insurance for everyone regardless of income, and it didn’t halt the health insurance exchanges.

The policy idea being tested is that the Affordable Care Act gave states the option to expand Medicaid to cover more low‑income adults by raising eligibility to 133% of the federal poverty level. This expansion was voluntary for states after the Supreme Court ruling, with the federal government covering the vast majority of the costs—initially 100% of the expansion and eventually about 90%. That combination—an expanded eligibility threshold and strong federal funding—made expansion a feasible choice for many states. The other options don’t reflect what the ACA implemented: it didn’t eliminate Medicaid, it didn’t require private insurance for everyone regardless of income, and it didn’t halt the health insurance exchanges.