Michelle Wilde Anderson & Lina Volin, The Next Chapter in Health Care Federalism: Expanding Medicaid from the ground up. 2025 Wis. L. Rev. 1223 (2025).
In much of the South and a few other conservative states, 1.4 million low-income adults have been excluded from access to Medicaid coverage. Now, in the wake of federal lawmaking in 2025, millions of additional Americans nationwide (including in these states) will lose access to Medicaid benefits and affordable health insurance. With America’s population of uninsured and underinsured people poised to grow dramatically, this might seem like a foolish time to talk about Medicaid expansion.
But new pressures can generate new politics. This Essay focuses on states that have opted out of Medicaid expansion, where a rising tide of newly uninsured people may nudge those states to seek new and politically low-profile ways to make up for lost ground. This Essay argues that local governments—particularly, multicounty partnerships brokered with these states’ biggest central hospital complexes—should be the focus of a new phase of policy development for low-income health care. Just as local governments were at the vanguard of Medicaid expansion in early Affordable Care Act implementation, they can become important leaders in a new wave of lawmaking to, at long last, bring health care access to low-income communities in the South and Midwest.
