Journal of Social Equity and Public Administration

Medicaid Expansion Case Study: Differences Between Florida and New York Medicaid Expansion Policy

Mary Zielinski

Medical University of South Carolina

Jillian Harvey

Walter Jones

Jiebing Wen

DOI: https://doi.org/10.24926/jsepa.v2i2.5593

Keywords: Medicaid policy, Medicaid expansion, Affordable Care Act, State Medicaid, Medicaid access

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Abstract

Health access is an essential aspect of social equity. Expanding Medicaid under the Affordable Care Act (ACA) has increased healthcare access for more than 21 million people in the United States, and 10 states have chosen not to participate in Medicaid expansion. This study investigates the factors influencing states’ decisions on Medicaid expansion under the ACA and its implications for social equity. It uses a comparative case study of New York (expansion) and Florida (non-expansion) to reveal the complex determinants of Medicaid expansion decisions. These determinants are crucial for understanding and promoting social equity in pursuing public purposes. Political affiliations, lobbying, and a state’s economic climate significantly shape Medicaid policies. Unfortunately, grassroots advocacy groups encountered significant challenges in Florida, where health associations tended to align closely with their state political parties. Despite the challenges, organizations must advocate for improved healthcare access and Medicaid expansion to address social equity concerns.

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Author Biographies

Mary Zielinski, Medical University of South Carolina

Mary Zielinski (mz81110@gmail.com) recently graduated from the Medical University of South Carolina, attaining a doctorate in Health Administration. She holds a master’s of science in Health Administration from Utica College and is interested in qualitative research in healthcare operations and health policy.

Jillian Harvey

Jillian Harvey (harveyji@musc.edu) is a professor in Healthcare Leadership and Management at the Medical University of South Carolina and director of the Doctor of Health Administration Division. Her research experience includes program evaluation, healthcare quality improvement, and mixed methods research approaches.

Walter Jones

Walter Jones (jonesw@musc.edu) is Professor Emeritus at the Medical University of South Carolina, specializing in health policy’s impact on service delivery and outcomes. With a background in political science and economics, he contributes extensively through publications, conferences, and grant reviews for prestigious institutions like NIH/NIAID, CPRIT, and CDMRP.

Jiebing Wen

Jiebing Wen (jiw4010@med.cornell.edu) is a research associate in the Department of Population Health Sciences at Weill Cornell Medical College, Cornell University. Her work focuses on applying quasi-experimental econometrics techniques to answer research questions regarding the intended and unintended impact of health policies, as well as the politics of policy adoption.

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