Abstract

In 2015, the U.S. Supreme Court issued its ruling on the Patient Protection and Affordable Care Act (ACA). Among other things, it found that states may refuse to expand Medicaid to all individuals earning less than 133% of the federal poverty line. In this article, I evaluate the strongest conservative objection to the Medicaid expansion, which runs as follows: "Defenders of the ACA promised that the Medicaid expansion (and all other parts of the ACA) would be paid for with compensating cuts. However, it’s arguable that that claim is false and that the government is likely to follow its well-worn pattern of charging at least some of the increased spending to the national debt. Debt is already at dangerous levels, and adding to it increases the risk of a serious fiscal crisis. We should therefore oppose the Medicaid expansion." After laying out this argument, I evaluate its central claims and draw three main conclusions. First, some people could reasonably believe the assumptions behind the fiscal objection, and thus reasonably oppose the Medicaid expansion as well. Second, despite the fact that reasonable critics could hold those assumptions, most critics do not, and so they should not reject the Medicaid expansion on these fiscal grounds. Third, supporters of the ACA and the Medicaid expansion can reasonably reject the assumptions behind the fiscal objection, and thus the objection itself.