Colleen Grogan of the University of Chicago discusses how states are responding to the Medicaid expansion option contained in the Affordable Care Act, and how they might respond in the near future. According to Grogan, the Medicaid expansion is extremely important politically in that it could change the perception of publicly subsidized healthcare from "welfare medicine" to a "middle class entitlement." Even before the ACA, says Grogan, Medicaid was the largest health plan in the United States, covering one third of children and a large number of poor, elderly, and disabled adults. It has been expanding steadily, she observes, as states increasingly push services into the program in order to receive federal matching funds. Grogan predicts that despite the current political turmoil, it is highly likely that by 2020 nearly all 50 states will have adopted the expansion.

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