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D. Berwick (2013)
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Opinion VIEWPOINT Practical and Political Considerations for Expansion It has long been anticipated that 2014 would be the ate an exchange (Table), including 6 led by Republican David K. Jones, MSPH, MA year in which most major elements of the Patient Pro- governors. This difference is not surprising, given that Department of Health tection and Affordable Care Act of 2010 (ACA) would be much more federal funding is at stake with the Medic- Management and implemented. Yet even after surviving legislative, judi- aid decision. By comparison, Idaho is the only state to Policy, School of Public cial, and electoral challenges, what the law actually will forgo the Medicaid expansion but create a state or part- Health, University of Michigan, Ann Arbor. accomplish is uncertain. A major reason is the promi- nership exchange. nent role given to the states over the implementation of The policy implications of these decisions are enor- 2,3 Phillip M. Singer, the ACA. mous. Nearly 2.6 million Americans in the 25 states not MHSA State flexibility is a double-edged sword. By shift- expanding Medicaid will fall into a coverage gap. These Department of Health ing some difficult decisions from the federal govern- people will be too
JAMA – American Medical Association
Published: May 21, 2014
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