Critique on Medicaid Expansion Under Affordable Care Act


Affordable Care Act (ACA) refers to comprehensive health care legal reforms and amendments. ACA addresses health insurance coverage, costs as well as preventive care. The reform was passed into two categories, namely, The Patient Protection and Affordable Care Act which was accepted as law in 2010, and Health Care and Reconciliation Act on March 30, 2010 (Blavin & Ramos, 2021). Under the Affordable Care, several transformations were evident such as the inclusion of low-income individuals in sensitive medical covers and also an increase in the use of health facilities among different groups (Fang, 2017).

This paper presents a critique of an article on Affordable Care titled ‘Association of Medicaid expansion under the patient protection and Affordable Care Act with use of long-term care’ by Courtney et al. in 2020. The factions discussed in this paper shall be from thorough exploration through other media sources concerning the same subject.

Critiquing the Article

Medicaid has been widely associated with high access to healthcare and also the quality of delivery for the same services. According to Courtney et al. (2020), Medicaid has led to the embracing of long-term care by individuals who are covered by the act. The authors argue that the trend has been evident for newly qualified low-income individuals. In a study that the authors conducted among 891 individuals, the ACA-funded Medicaid expansion resulted in a 4.4% increase in the feasibility of any long-term care among low-income adults and other eligible groups (Courtney et al., 2020). Therefore, as by Courtney et al. (2020), the expansion of Medicaid has led to an increase in long-term care for the newly eligible peasants. That suggests population covered by Medicaid expansion may have experienced challenges when it comes to long-term care before the expansion took place.

To give a credible critique on this matter, it is important to view what other authors have suggested concerning the ACA in the US. Walker et al. (2020) researched the effect of Affordable Care on Medicaid payments in long-term care settings. According to what the authors insinuate, Courtney et al.’s provisions of ACA are logical as the increase in the number of people seeking long-term care may have changed the payment. It is true to say that after the expansion, it means people would get waves in terms of costs that were set initially.

It was found that ACA led to increased Medicaid payments and the number of uninsured individuals went down significantly. After the implementation of Medicaid expansion, nursing homes and lifelong care facilities have seen a high number of patients seeking long-term services (French et al., 2016). It is a fact that under ACA, Medicaid has led to a high number of low-income groups seeking care services on a long-term basis (Guth & Garfield, 2020). The reason is that most of the people looking for such services may not be well-established when it comes to financial stability.

It is also important to critique the article based on what other people say about the ACA and long-term care admissions in the US. The expansion has some limitations based on the low-income groups seeking long-term care (Walker et al., 2020). The author says that most US nationals do not think they need long-term care. However, those who do often mistakenly believe that their health insurance covers the services, which in most cases could be an underestimation (Schwehr et al., 2021). When people start aging, it becomes hard to determine in advance if they need long-term care, and also, the low-income groups, they may not realize that due to financial challenges that are evident to them. Therefore, according to what Courtney et al. (2020) suggest on increased coverage of long-term care, it may not be true for all people in the US. The reason is that many do not have an advanced plan concerning their healthcare issues.

The expansion of Medicaid under the ACA may limit the US health insurers’ profitability margins on a short-term basis. Participating in Medicaid Managed Care Organizations (MCOs) will see higher enrollments than before (Kim & Koh, 2019). Regrettably, the benefits for most of the insurers may be low in terms of profitability until the expansion takes a significant embrace by all the parties in the US (Hendryx & Luo, 2018).

Since the start of Medicaid expansion under ACA, insurers have reported a 3% fall in terms of the capability to reach their targets on returns on revenue (ROR) (Kim, 2016). Thus, since most of the groups adopting the Medicaid offers under the newly expanded provision may be of low income, it means that profit levels for the institutions offering such services will be affected (Hendryx & Luo, 2018). When the care facilities face hard financial issues, the general health impacts may be adverse in the US, for that matter.


The expansion of Medicaid as per the ACA provisions has led to an increase in the number of people who seek long-term services. The reason why the increase is notable is due to the cost that is slightly friendly for the newly eligible groups. However, due to the adoption of the matter, it may be hard for the care providers to have profits before the expansion takes stable roots in all parts of the US. Therefore, it is important to be sensitive about the insurance option that one takes based on their health requirements.


Blavin, F., & Ramos, C. (2021). Medicaid expansion: Effects on hospital finances and implications for hospitals facing COVID-19 challenges. Health Affairs, 40(1), 82-90. Web.

Courtney, H., McGarry, B., Jutkowitz, E., & Grabowski, D. (2020). Association of Medicaid expansion under the patient protection and affordable care act with the use of long-term care. JAMA Network Open, 3(10), e2018728. Web.

Fang, C. (2017). The effect of affordable care act Medicaid expansion on post-displacement labor supply among the near-elderly. SSRN Electronic Journal, 8(5), 22-25. Web.

French, M., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the patient protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735-1771. Web.

Guth, M., & Garfield, R. (2020). The Effects of Medicaid expansion under the ACA: Studies from January 2014 to January 2020. KFF. Web.

Hendryx, M., & Luo, J. (2018). Increased cancer screening for low-income adults under the Affordable Care Act Medicaid expansion. Medical Care, 56(11), 944-949. Web.

Kim, D. (2016). Health insurance and labor supply: Evidence from the Affordable Care Act early Medicaid expansion in Connecticut. SSRN Electronic Journal, 8(23), 21-25. Web.

Kim, S., & Koh, K. (2019). The effects of the Affordable Care Act Medicaid expansion on subjective well-being. SSRN Electronic Journal, 5(3), 3-4. Web.

Schwehr, N., Alarcón, G., & Hartman, L. (2021). Impacts of the Affordable Care Act Medicaid expansion in California. California Journal of Politics and Policy, 13(1), 12-24. Web.

Walker, V., Ruley, M., Nelson, L., Layton, W., & Coustasse, A. (2020). The effect of the Affordable Care Act on Medicaid payments in long-term care facilities. International Journal of Healthcare Management, 6(3), 1-8. Web.

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