Conservatives' beloved President Ronald Reagan expanded and improved upon Medicaid several times over his two terms, 1981-1989. From the Kaiser Family Foundation, a recap of those actions follows after the break.

1981: OBRA 81 repealed a requirement that states
pay Medicare hospital payment rates, but also
allowed states to make additional payments to
hospitals serving a disproportionate share of
Medicaid and low-income patients
. These hospitals
become known as disproportionate share hospitals
(DSH).

1981: While section 1115 waiver authority predated
the Medicaid program, OBRA 81 established two new
types of Medicaid waivers. The first, section 1915(b)
freedom-of-choice waivers, allowed states to pursue
mandatory managed care enrollment of certain
Medicaid populations. Prior to this new waiver, less
than one percent of the managed care population is
enrolled in managed care. The second, section
1915(c) HCBS waiver, allowed states to cover home
and community-based long-term care services for
the elderly and individuals with disabilities at risk of
institutional care
.

1982: TEFRA allowed states to extend Medicaid
coverage to"Katie Beckett" children under age 18
with disabilities requiring institutional care but living
at home
by waiving requirements that families fall
within SSI income restrictions.

1984: The Deficit Reduction Act of 1984 mandated
coverage of children born after September 30, 1983,
up to age 5, of AFDC-eligible families. Coverage for
AFDC eligible first-time pregnant women and
pregnant women in two-parent unemployed families
also becomes mandatory
.

1985: The Consolidated Omnibus Budget
Reconciliation Act of 1985 mandated coverage for all
remaining AFDC eligible pregnant women
.

1986: The Omnibus Reconciliation Act of 1986
(OBRA 86) required states to cover treatment of
emergency medical conditions for illegal immigrants
otherwise eligible for Medicaid
.

1986: OBRA 86 also gave states the option of
covering pregnant women and infants (up to 1 year
of age) up to 100 percent of federal poverty level
(FPL)
and allowed states to pay for Medicare
premiums and cost-sharing for low-income qualified
Medicare beneficiaries (QMBs) with income at or
below 100 percent of FPL.

1987: The Omnibus Reconciliation Act of 1987
(OBRA 87) gave states the option of covering
pregnant women and children under age 1 in
families with income up to 185 percent of FPL
.

1987: OBRA 87 also enacted nursing home reforms
that upgraded quality of care requirements and
revised monitoring and enforcement of facilities
participating in Medicaid
.

1988: The Medicare Catastrophic Coverage Act of
1988 (MCCA) required states to pay the Medicare
premiums and cost-sharing for low-income Medicaid
beneficiaries with incomes below 100 percent of FPL
(QMBs)
.

1988: The Family Support Act of 1988 required
states to extend 12 months transitional medical
assistance (TMA) to families losing AFDC cash
assistance due to earnings from work
.

1989: The Omnibus Budget Reconciliation Act of
1989 (OBRA 89) mandated coverage for pregnant
women and children under age 6 in families with
incomes at or below 133 percent of FPL (whether or
not they were receiving AFDC cash assistance)
.

1989: OBRA 89 expanded the EPSDT benefit for
children under 21 to include needed diagnostic and
treatment services even if the services were not
covered for adult beneficiaries
.

1989: OBRA 89 also required states to cover
services provided by federally-qualified health
centers (FQHCs)
.

So how did it come to pass in 2017 that conservatives now believe it's acceptable to purposefully up the number of uninsured Americans by 22 million?

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Lost Medicaid Funding

To date, the failure to expand Medicaid/TennCare has cost the State of Tennessee ? in lost federal funding. (Source)

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