J Health Care Poor Underserved. 2021;32(1):68-89. doi: 10.1353/hpu.2021.0009.
Federalizing Medicaid (thereby eliminating state program variation) is a bold and affordable alternative to Medicare for all (M4A) and proposed ACA public options. Making Medicaid an entirely federal program using Congress' budget reconciliation process will reverse the U.S. Supreme Court ruling that enabled states to reject Medicaid expansion. Such legislation achieves Congress' original intention to create universal entitlements for low-income persons who lack health coverage and concentrate new federal health spending on them (unlike M4A). Arguments for federalizing Medicaid involve state budget relief, efficiency, social justice and the history that created national industries from local and state-based health systems. Theory suggests that liberal democracies are generally more successful when path dependent, building incrementally on existing policies instead of plunging into new, untested innovations no matter how rational. In addition to realizing the congressional intent of the ACA, federalizing Medicaid can be a cost-effective, incremental path to single-payer health coverage.
将医疗补助（Medicaid）联邦化（从而消除各州项目的差异）是一种比全民医疗保险（Medicare for all，M4A）和拟议的 ACA 公共选择更具胆识且负担得起的替代方案。使用国会的预算和解程序将医疗补助完全变为联邦项目，将推翻美国最高法院允许各州拒绝扩大医疗补助的裁决。此类立法实现了国会为缺乏医疗保险的低收入者创造普遍权益的初衷，并将新的联邦卫生支出集中用于这些人（与 M4A 不同）。支持医疗补助联邦化的论点涉及到州预算缓解、效率、社会正义以及从地方和州立卫生系统创建国家产业的历史。理论表明，当依赖于路径，在现有政策基础上逐步推进而不是贸然采用新的未经检验的创新时，自由民主国家通常会更成功，无论这些创新多么合理。除了实现 ACA 的国会意图之外，医疗补助的联邦化还可以成为实现单一支付者医疗覆盖的具有成本效益的渐进式途径。
