Designers of Obamacare and the administration all predicted confidently - even after the Supreme Court ruled that states could not be forced to expand Medicaid - that even Republican states would fall in line eventually.
After all, the reasoning went, what governor in their right mind would turn down all those federal dollars? Washington promised to fund 100% of the expansion for 3 years and then never less than 90% thereafter. Surely GOP governors would cave and bring this wonderful benefit to their poorer citizens.
But only 24 states are on board to fully expand Medicaid. As you might suspect, the best laid plans of mice, men, and Democrats...
As predicted, Republican governors started flipping. First Gov. Brian Sandoval of Nevada endorsed a full expansion. Then came the governors of New Mexico, Arizona, Ohio, Michigan. Even Rick Scott, the Florida governor elected on an anti-Obamacare platform, said expanding Medicaid was the right thing to do. Chris Christie followed suit in New Jersey, as did others. But endorsements haven't always led to expansions. The Florida Legislature did not share the governor's conversion, and Scott quickly backed down. At press time, both Ohio and Arizona's Legislatures continue to debate expansion.
Other governors who were considered obvious gets--such as Pennsylvania's Tom Corbett and Tennessee's Bill Haslam--declined expansion. Some of the poorest states with the most to gain have left piles of federal cash on the table. Medicaid was such a toxic issue in Mississippi that the Legislature adjourned without even reauthorizing the state's current program. While governors know they'll be judged on the health of the state economy, many legislators care more about ideological purity, and few Republican lawmakers are interested in the political risk associated with voting for anything branded with the president's name. Brian Haille, a former health aide to Haslam, says he doesn't expect any Medicaid enthusiasm in Tennessee until after the Republican primary filing deadline next year. "You've got lawmakers who are ducking and covering and do not want to vote on anything related to Obamacare before then," he said.
There may still be some stragglers. Kentucky Democratic Gov. Steve Beshear announced in May his state would move forward (he doesn't need legislative approval). Republican Gov. Terry Branstad in Iowa, an early skeptic about Medicaid, just reached an agreement with his Legislature to expand. But to do so, he needed to rebrand the program as something else. The plan, which still needs federal approval, will move some poor residents into private insurance markets and other into a state-run program that covers different benefits and pays doctors differently from the state's existing Medicaid program. "It isn't Medicaid expansion," insists Michael Bousselot, a policy adviser to Branstad, although he notes that it will use the federal funds. Utah Gov. Gary Herbert tells NJ he won't be making a Medicaid decision until at least September.
One of the big reasons that governors are leery of expanding Medicaid is that despite the promises of the federal government, few believe they will live up to the rules and states will be stuck holding the bag on massively increased Medicaid costs after 3 years or so. That, and the ridiculous rules to which states must adhere are a recipe for potential risk of fiscal disaster that many governors refuse to run.
Just one more indication that the Obamacare rollout is going to be a clusterfark of massive proportions.