Trapped in America's Safety Net

most Americans will eventually be eligible for Medicare, a federal program. If some of them are in poorer health by the time they reach the age of sixty-five because they were uninsured as adults due to state policy (such as narrow Medicaid eligibility), then the national program is worse off: those people will end up being more costly than healthier individuals from a state that provides more expansive social assistance. Beyond these pragmatic matters is the fact that the national government is supposed to promote “the general welfare.” Dramatic cross-state differences in public policy arguably conflict with this tenet of American citizenship.