Why Are Some States Reluctant to Implement the ACA Medicaid Expansion? Focusing on State Fiscal Capacity.

This study considers the 2010 Patient Protection and Affordable Care Act (ACA) Medicaid expansion and examines why some states have been reluctant to implement the expansion by focusing on state fiscal factors, including budget solvency, long-run solvency, and federal Medicaid assistance percentages (FMAPs). We used data and samples from multiple sources covering nine years (2012 –2020) and 50 states. Our estimation strategy was an event history analysis with robust standard errors to resolve the possible heteroscedasticity problem. The findings show that states' Medicaid expansion decisions were associated with increased long-run solvency and were marginally associated with decreased budget solvency, providing evidence for the significance of state fiscal capacity in shaping policy decisions. The FMAP influenced the adoption of the Medicaid expansion. [ABSTRACT FROM AUTHOR]