President Obama is giving the holdouts a second chance. In remarks at a town hall gathering late last week, the president said he plans a final push to get every state to expand Medicaid.
"We're hoping to encourage more states to do the right thing," Obama said, according to Reuters.
There remain 19 states that do not participate in the expansion of Medicaid that was set up as a major component of the Patient Protection and Affordable Care Act. Although a handful of states — most recently Louisiana — have changed course since PPACA's implementation, many of the remaining holdouts, all of which are Republican-controlled, are stubbornly opposed to the expansion, which extends coverage to those with incomes up to 138 percent of the federal poverty level.
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PPACA originally mandated that states expand Medicaid, but that provision was struck down in a 2012 Supreme Court decision that was otherwise favorable to the health law.
As a result of the court's decision, states were given the option of taking part in the expansion, which is entirely funded by the federal government through 2016 and will be 90 percent federally-funded from 2020 on.
The issue quickly became polarized along partisan lines, with many Republican state leaders reluctant to take part in anything associated with Obamacare.
There were nevertheless cracks in the GOP opposition to the expansion from the beginning, notably from Ohio Gov. John Kasich, who accepted the expansion, which he justified with altruistic and religious reasoning. And in the past year, other Republican governors have decided to accept the expansion in return for federal waivers that allow them to impose more cost-sharing on Medicaid beneficiaries, such as monthly premiums.
Obama says he plans to ask Congress to authorize a tempting carrot for the holdouts: If they choose to expand, they will enjoy three years of 100 percent federal funding of the newly-eligible enrollees, just like the states that chose to expand at the beginning.
But, like many things in Washington D.C. these days, it's a goal that's easier stated than accomplished. While state GOP leaders may be warming up to the idea of accepting federal dollars that other states have benefited from, Congressional Republicans are unlikely to advance any policy that they see as further enshrining Obamacare as part of the social safety net.
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