Critical Analysis

1. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.On March 27, 2023, North Carolina Governor and professional news anchor impersonator, Roy Cooper signed into law legislation that would direct the state to expand Medicaid. Based on the amazingly stunning visual above, now that NC (the best state in the union) has expanded medicaid coverage, what number of states still have not adopted medicaid expansion?

2. Effective January 1, 2014 The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,120 for an individual in 2023) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. Because the federal government pays 90% of the cost of this program most states initially paid the 10% and joined the medicaid expansion, others did not. Based on the life-alteringly wonderful visual above, roughly what percentage of all American states have now adopted expanded medicaid?

3. Based on the visual above, and the map of party affiliation by state (below)* draw a conclusion about the states that have not yet adopted medicaid expansion.

4. North Carolina’s Medicaid expansion ensured access to affordable health insurance coverage for more than 600,000 North Carolinians. Which increases access to health care— including mental health and substance use services— across the state, particularly in rural communities. Research shows that when states expand Medicaid, it saves lives. A study found that Medicaid expansion was associated with nearly 12 fewer deaths per 100,000 adults each year in expansion states. That is because people with health coverage are more likely to get preventative care, more likely to catch and treat diseases like cancer and heart disease early, and less likely to skip medications because of the cost. If you were governor Roy Cooper, explain whether you would have signed that medicaid expansion into law.

5. For years the NC state Republican legislature has been staunchly opposed to medicaid expansion, but as medicaid has become more popular the Republican controlled legislature finally relented and allowed over half a million Tarheels (North Carolinians) to get health insurance. How do you explain the legislature’s change of heart.

6. When Social Security first began it was ridiculed and shunned by many states. Over time social security became wildly popular and opposition to Social Security became a “third rail” in politics - meaning that a politician voting against Social Security, was like a person touching the electrified third rail of a subway: instant death. Based on that history and the visual below* explain whether eventually all states will accept Medicaid expansion - even Texas.

7. Make a connection between the data in the map above and the concept of federalism.

8. Robert Yates, probable author of Brutus 1, the Anti-Federalist manifesto, was concerned about a tyrannical government taking away the rights of states and individuals. Make a claim about Medicaid expansion from the perspective of an Anti-Federalist.

9. Texas has the highest rate of uninsured people of any American state. Explain why you think that is. (For example, did the people of Texas demanded from their legislatures that their state have a super-high rate of uninsured people? Is health care more expensive in Texas? Do people in Texas just not want insurance?)

10. They say that federalism allows people to “vote with their feet.” If you lived in Colorado (which thanks to their Medicaid expansion has a very low rate of uninsured people) versus next-door-neighbor Wyoming (which thanks to their refusal to expand Medicaid) has more than double the rate of uninsured people, explain how likely you would be to move?

Learning Extension

Check out this interactive map from the Kaiser Family Foundation about insurance rates in each state.

Action Extension

Contact a member of your state legislature and ask them if they voted to expand Medicaid. Let them know whether you believe your state should expand Medicaid or not.

Visual Extension*