It was largely conservatives who blocked President Trump's attempts to repeal the Affordable Care Act, arguing that his proposed replacement bill was "Obamacare light." The consequence, noted Speaker Paul Ryan, is that the ACA remains the law of the land.
In fact, now that the ACA repeal is dead, there is a fresh push around the country, including by Republicans, to further solidify President Barack Obama's signature domestic policy.
In 19 states that have still not accepted the ACA Medicaid expansion, political leaders in both parties are pushing to reverse course.
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Last week, both houses of the GOP-controlled legislature in Kansas voted to approve expanding Medicaid eligibility to all families with incomes up to 138 percent of the federal poverty rate, as 31 other states and the District of Columbia have done.
"I've never had anything like that in the legislature," state Sen. Barbara Bollier, a Republican and doctor who pushed for the expansion, tells NPR. "It was just overwhelming support. Not just support; begging, pleading, 'Please, we desperately need this in place.' "
Indeed, polls have shown that Kansans overwhelmingly back expanding Medicaid.
However, Gov. Sam Brownback, a hardline conservative, vetoed the bill. Supporters of the bill will have to find several more votes if they hope to override his veto.
Similarly, in Maine, the legislature's repeated bipartisan votes to expand Medicaid have been vetoed by Republican Gov. Paul LePage, a hard-right political leader.
However, state law allows for the question to be put to a citizen referendum, which is what will happen this November due to 67,000 signatures an activist group gathered on Election Day 2016.
In neighboring Missouri, the Republican governor was far more successful in getting legislators to toe the party line. A proposal to expand Medicaid failed 42-101 in the state's GOP-controlled House of Representatives.
Republicans in Tennessee are also facing calls from Democrats to expand. State House Minority Leader Craig Fitzhugh called the failure of Trump's plan a "manna from heaven" that he hopes will allow the state to embrace the expansion, which would bring the state $2.5 million in federal funds every day.
Thus far, GOP Gov. Bill Haslam and Republican leaders in the state legislature appear to remain opposed to expansion, however.
In Virginia, it's Democratic Gov. Terry McAuliffe who is imploring the GOP-controlled legislature to expand. But legislative Republicans there won't budge, saying in a recent joint statement that the state can't afford to put any more money into Medicaid. While the Medicaid expansion is funded 90 percent by the federal government, it still requires some state spending.
McAuliffe attributes the opposition from Republicans to fears that they will be ousted in primaries by challengers from the right if they are seen as supporting a Democratic policy.
"My legislature is terrified of the Tea Party," McAuliffe tells NPR. "That's the only reason they're not voting for it. Because they're afraid they'll get taken out in the primary, plain and simple."
Democrats see the GOP's failure to replace the ACA as potentially paving their path back to power in next year's midterm elections. However, the minority party is divided on the extent to which it should engage with Republicans, including Trump, on making fixes to the ACA.
House Democratic Leader Nancy Pelosi is cautioning Democrats to avoid offering specific health care policies, instead focusing on their united opposition to Trump.
Other Democrats, however, say that their party should not seek to replicate the GOP's "party of No" strategy. It's shallow in terms of policy, and it will do little to inspire voters who have strayed from the Democrats in recent years to come back.
"In a district like mine, it would not be enough to say, 'We're going to fight this,'" Rep. Cheri Bustos, D-Ill., who represents a swing district, tells The Hill. "You can't just say, 'We're going to fight it,' and not have answers."
In addition, many from the Bernie Sanders wing of the party are agitating for Democrats to be bolder on the issue, and to start making the case for a "Medicare for all" or at least a government-run "public option" insurance program.
Sen. Elizabeth Warren, D-Mass., recently expressed support for a public option: "My view on this is, when it's time to take a step back and say, 'What is the right way to do health care in America,' I think that's when it's time to put it all on the table. Not just small adjustments."
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