As a whole, the large body of research on the effects of Medicaid expansion under the ACA suggests that expansion has had largely positive impacts on coverage; access to care, utilization, and affordability; and economic outcomes, including impacts on state budgets, uncompensated care costs for hospitals and clinics, and employment and the labor market. With ACA repeal and replacement remaining a priority for the Trump Administration and Congress, these findings suggest that gains in coverage and access as well as economic benefits to states and providers are at stake if the Medicaid expansion is repealed.
In his 1967 paper, Arbitrary and Natural Reinforcement , Charles Ferster proposed classifying reinforcement into events that increase frequency of an operant as a natural consequence of the behavior itself, and events that are presumed to affect frequency by their requirement of human mediation, such as in a token economy where subjects are "rewarded" for certain behavior with an arbitrary token of a negotiable value. In 1970, Baer and Wolf created a name for the use of natural reinforcers called "behavior traps".  A behavior trap requires only a simple response to enter the trap, yet once entered, the trap cannot be resisted in creating general behavior change. It is the use of a behavioral trap that increases a person's repertoire, by exposing them to the naturally occurring reinforcement of that behavior. Behavior traps have four characteristics: