From Flexibility to Forced Alignment: The One Big Beautiful Bill Act's Reshaping of Medicaid Federalism.
The One Big Beautiful Bill Act (OBBBA) enacted historic cuts to Americans' safety net and narrowed the state flexibility that has long characterized Medicaid federalism. By compelling new Medicaid cost-sharing of up to $35 per service, the implementation of new work requirements, and more frequent e...
| Publicado en: | Publius: The Journal of Federalism Vol. 56; no. 3; pp. 711 - 733 |
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| Formato: | Artículo |
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Oxford University Press / USA
Summer2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195587500&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195587500 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00485950 UBL jtl: Publius: The Journal of Federalism issn: 00485950 maglogo: N pubinfo: dt: Summer2026 vid: 56 iid: 3 pid: 622 pub: Oxford University Press / USA artinfo: ui: 195587500 10.1093/publius/pjag025 ppf: 711 ppct: 22 formats: tig: atl: From Flexibility to Forced Alignment: The One Big Beautiful Bill Act's Reshaping of Medicaid Federalism. aug: au: Yaver, Miranda affil: Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA 15213, USA su: Medicaid Quality of life Discretion Health services accessibility One Big Beautiful Bill Act Medicaid costs sug: subj: Medicaid Quality of life Discretion Health services accessibility Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs) One Big Beautiful Bill Act Medicaid costs keyword: copyrightHolder:CSF Associates Inc. copyrightYear:2026 health care health policy inLanguage:en policy implementation public policy publisher:Oxford University Press sameAs:https://dx.doi.org/10.1093/publius/pjag025 social welfare state politics subnational politics welfare policy copyrightHolder:CSF Associates Inc. copyrightYear:2026 health care health policy inLanguage:en policy implementation public policy publisher:Oxford University Press sameAs:https://dx.doi.org/10.1093/publius/pjag025 social welfare state politics subnational politics welfare policy ab: The One Big Beautiful Bill Act (OBBBA) enacted historic cuts to Americans' safety net and narrowed the state flexibility that has long characterized Medicaid federalism. By compelling new Medicaid cost-sharing of up to $35 per service, the implementation of new work requirements, and more frequent eligibility redeterminations, as well as precluding many immigrants from enrolling in Medicaid, CHIP, and Affordable Care Act marketplace plans, the law ties states' hands in the delivery of health insurance, with harsh federal penalties for noncompliance. This article reviews Medicaid's historic roots in federalism, and its intersection with state-driven policies emanating from the ACA. It then contextualizes prior state Medicaid policies in the administrative burden framework. It then details the core ways that the OBBBA intrudes on state flexibility in health insurance delivery, while also likely spurring a deepened partisan divide in implementation choices. It concludes by offering reflections on the future of healthcare access in this new policy landscape. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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