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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