Analyzing the Evidence Exercises


The 2010 Patient Protection and Affordable Care Act (ACA), which embodied key aspects of President Obama’s health care reform agenda, involves federalism—the relationship between states and the federal government. The ACA made eligibility for Medicaid, a program that provides health care for the needy, consistent across states. Prior to the ACA, states set the “threshold” at which people qualified for Medicaid.

Look at this figure from the Analyzing the Evidence section of Chapter 3. It shows the threshold for eligibility as a percentage of the Federal Poverty Level (FPL), with states that made it easier to qualify for Medicaid represented in lighter blue and states that made it more difficult to qualify represented in darker blue. For example, a state with an eligibility threshold set at 100 percent of the poverty level ($22,500 in 2009) for a family of four is represented by a medium shade of blue (corresponding to states with thresholds ranging from 80 to 119 percent of the FPL).

Medical Eligibility Threshold

Name the states that have the highest income eligibility threshold for Medicaid benefits.
Which states are in the group with the lowest income eligibility threshold for Medicaid benefits?
Taken as a whole, are there more states in the upper two or lower two categories of eligibility?

A number of states have filed lawsuits against the federal government, challenging the constitutionality of the ACA.i One of the arguments against it is that it imposes a uniform minimum threshold for Medicaid eligibility—133 percent of the FPL.ii Look at the table below, which shows the 10 states at each extreme in terms of current eligibility thresholds along with whether or not each state has challenged the law in federal court.iii

  Highest FPL threshold Lowest FPL threshold
Filed suit: ME, WI AL, ID, IN, KS, LA, TX, VA
No challenge: CT, IL, MA, MN, NJ, NY, RI, VT AR, MO, WV
Do the states that have filed suit generally have a high or low threshold for Medicaid eligibility?
Now look at the states that have not filed suit — do they generally have a high or low threshold for Medicaid eligibility?
What is one hypothesis you might offer for the relationship (or correlation) between state eligibility thresholds and the decision of a state to challenge the ACA in court? In your answer, be sure to describe WHY you think this hypothesis might be supported in the data presented above.

i National Conference of State Legislatures, “State Legislation and Actions Challenging Certain Health Reforms, 2011,” Table 2, (accessed 11/9/11). 

ii Joondeph, Bradley W. 2011. “Federalism and Health Care Reform: Understanding the States’ Challenges to the Patient Protection and Affordable Care Act.” Publius: The Journal of Federalism 41: 447-70. 

iii Source: Kaiser Family Foundation, “Income Eligibility Limits for Working Adults at Application as a Percent of the Federal Poverty Level (FPL) by Scope of Benefit Package, January 2011,” (accessed 11/9/11). 

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