Assessing a Very Costly Medicaid Expansion
Read the full document (PDF)In 2010, Congress passed the Patient Protection and Affordable Care Act (PPACA), a massive health care overhaul that asserted fresh federal control over nearly one-fifth of the U.S. economy. As written, the PPACA would have, among other things, forced states to expand their Medicaid programs or risk losing all of their existing Medicaid funding. Ultimately, the U.S. Supreme Court struck down the law's mandatory Medicaid expansion provision, finding that it was impermissible under Congress's spending power. As a result, states do not have to choose between expanding their Medicaid eligibility or losing federal funding for their entire Medicaid programs. Indeed, many states have already rejected the expansion.
Missouri policymakers have a decision to make, but if they are going to seriously consider expanding the state's Medicaid program, two fundamental — and so far, largely neglected — questions must be answered: How much would the expansion cost Missouri taxpayers, and how would the state pay for it?
(This publication page summarizes a full report; the complete analysis is a linked PDF, not reproduced here — see full_report_pdf above.)
View the original at Show-Me Institute →
As confirmed against the Show-Me Institute's website on August 15, 2026, the Institute's stated policy permits reprinting of its published articles and commentary provided the original author receives credit. Letting the Institute know about a reprint is appreciated but is not a condition of use.
This entry was archived under that permission as it stood on the date above. If the Institute's policy changes after that date, it does not apply retroactively to entries already reproduced here under the terms in effect at the time — this is a record of the grant as confirmed, not a live status check.
The original remains hosted at the Institute's own site — use the link below for the canonical version, current formatting, and any images.