This essay explores how the law of Medicaid after fifty years creates a meaningful principle of universalism by shifting from fragmentation and exclusivity to universality and inclusivity. The universality principle provides a new trajectory for all of American health care, one that is not based on individual qualities that are unrelated to medical care but rather grounded in non-judgmental principles of unification and equalization (if not outright solidarity). To that end, this Essay first will study the legislative reformation that led to universality and its quantifiable effects. The Essay then will assess and evaluate Medicaid’s new universality across four dimensions, namely governance, administration, equity, and eligibility. Each reveals a facet of universality that underscores this new principle’s importance for health care into the future.

Document Type


Publication Date

Winter 2015

Notes/Citation Information

Yale Journal of Health Policy, Law, and Ethics, Vol. 15, No. 1 (Winter 2015), pp. 67-87