National Federation of Independent Business’s Impact on State Medicaid Programs & the Rise of Federalism by Waiver

On March 23, 2010 President Barack Obama signed the Patient Protection and Affordable Care Act (hereinafter “ACA”) into law. The enactment of the ACA was an enormous step in the history of the United States, as “no prior administration had successfully pushed national health reform through Congress, despite several attempts.” The Act was created with the primary goal of providing all American citizens with quality, affordable healthcare while also establishing mechanisms to curb the unsustainable growth of healthcare costs in the United States. In order to achieve one of its main objectives—the expansion of healthcare coverage to currently uninsured citizens—the ACA contains provisions that extend Medicaid to all individuals earning less than 133% of the federal poverty level (FPL). The act also provides subsidies, through healthcare exchanges, to Americans earning between 133% and 400% of the FPL, without access to affordable employer-sponsored health insurance. The Congressional Budget Office estimates that these provisions, along with others such as the “minimal essential coverage provision” or “individual mandate,” will increase the number of individuals with coverage by thirty-two million