The COVID pandemic caused the shutdown of the country that put the economy in a free fall.  Lost jobs mean less employer health insurance coverage, resulting in an increase of individuals who may qualify for expanded Medicaid. Increased demand on the healthcare system due to COVID brings healthcare to the forefront of our minds. The combination of more Americans with less insurance coverage and the demand for more healthcare services creates the ideal opportunity to push for the expansion of Medicaid and potentially nationalization of Medicaid. 

Expanding insurance coverage, whether in the form of public or private health insurance, was a critical goal of the Affordable Care Act.  But Congress overreached when it required states to expand their Medicaid programs because Medicaid is a dual state and federal program, not just a federal program like Medicare. Many states chose to expand Medicaid, while sixteen states chose not to do so.   

Recently, Oklahomans narrowly passed a ballot initiative to amend their state Constitution to expand Medicaid to adults with an income less than 138% of the poverty level.  On August 4th Missourians will vote on a similar ballot initiative.  In April, South Dakota Democrats called on Governor Kristi Noem to issue an executive order to expand Medicaid, along with other COVID related actions. 

Riding the pandemic wave that will encourage support for Medicaid expansion, pundits will increasingly call for nationalizing Medicaid. Nationalizing Medicaid will have two effects. First, it fundamentally undermines the states’ sovereignty by eroding one of the states’ fundamental responsibilities, defending the health of its citizens. Involving the federal government will most certainly stifle innovative approaches to healthcare at the state level.  

Secondly, nationalizing Medicaid will bring the country one step closer to a nationalized healthcare system.  Expanded federal health programs at both ends of the spectrum makes it easier to push for and implement an expansive national healthcare program. The pandemic upended our lives, and there will be both positive and negative effects on how we live and work. Will a nationalized Medicaid program be one of those outcomes?