The week’s Paragon Pic highlights the significant expansion in Medicaid enrollment over the last three decades, demonstrating that it is no longer solely a safety net for categories of just low-income Americans. Enrollment as a percentage of the U.S. population has more than tripled, rising from around 8 percent in the late 1980s to nearly 27% by 2022. Over this period, the poverty rate has remained relatively stable, further illustrating Medicaid’s transformation from a program primarily serving the poor and vulnerable to one that now covers a broad segment of the population.
The most transformative change came with the Affordable Care Act (ACA), which allowed states to expand Medicaid to able-bodied, working-age adults with incomes up to 138% of the federal poverty level. This marked a major shift, as Medicaid eligibility was no longer tied strictly to categorical requirements (such as being a parent, child, pregnant, or having a disability).
Paragon has written extensively on how Medicaid expansion has led to many problems, including a diversion of resources away from traditional Medicaid enrollees, a near quadrupling of Medicaid’s improper payments, and a surge of spending that has significantly contributed to ballooning federal deficits. Paragon also has written about how easy it is for people to qualify for Medicaid long-term care services, as the easy ability to artificially impoverish parents, aunts, and uncles has enabled heirs to protect their inheritances and pass costs to their fellow Americans.
