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 Some half dozen holdout states have been considering whether to join
28 states and the District of Columbia in accepting billions of
federal dollars to expand Medicaid under the Affordable Care Act,
President Barack Obama's program to provide healthcare to most
Americans.
A brawl broke out this week in Montana, where a Republican House
committee effectively killed the last legislation allowing the state
to take the federal money.
However, supporters of the measure outmaneuvered opponents on
procedural rules and resurrected the bill, and moderate Republicans
helped push it through a tight vote late on Thursday, giving it a
strong chance of becoming law.
The showdown in Montana lays bare a bitter ideological divide
stalling the expansion of Medicaid coverage in states concentrated
in the U.S. South and central West.
At one point, experts had predicted that up to a dozen of them could
reverse course this year and open up to Obamacare.
That would require providing coverage to working adults who fall
into a so-called coverage gap under Obamacare - too poor to purchase
plans under its health insurance exchanges, but unable to qualify
for traditional state Medicaid programs.
"Medicaid expansion is a real challenge for Republicans and it has
been harder for Republican legislators than governors," said
Caroline Pearson, senior vice president of Washington-based
healthcare consultants Avalere.
In many states now debating expansion, business groups and moderate
Republicans have come around to the economic arguments for accepting
the federal money, but cannot persuade GOP hardliners vulnerable to
Tea Party sympathizers.
AMERICANS FOR PROSPERITY
The debate has aroused conservative opposition backed by Americans
for Prosperity, a political group supported by billionaire brothers
David and Charles Koch.
From Florida to Tennessee, the group has taken to the airwaves and
flooded mailboxes to blast state Republicans for wavering on
Obamacare.
Americans for Prosperity has 10 field offices in Florida, the
largest presidential swing state, where it has staged a high-profile
campaign to stop Obamacare.
With the Republican legislature deadlocked on the issue, Governor
Rick Scott backpedaled on Monday on his earlier support, long tepid.
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"We hold politicians accountable, regardless of their party,
particularly if they use the mantle of 'conservative' or 'limited
government principles' and then they do the opposite," said Adam
Nicholson, a regional communications manager for Americans for
Prosperity.
Tennessee has also felt the influence of the group's field
operation, which can deploy more than 500 staffers on Medicaid and
other issues in 33 states, up from fewer than 100 in 2010.
The group helped defeat the Medicaid expansion plan championed by
Tennessee's Republican Governor, Bill Haslam, by linking it to
Obamacare.
"Tennessee is a red state and there is a reaction to anything that
is associated with Obamacare," said Charlie Howorth, spokesman for
the pro-expansion Coalition for a Healthy Tennessee, which is backed
by business groups and hospitals.
Similar fights are in their final rounds in Alaska and Missouri. In
Utah, one of few states where the issue remains in play, the
legislature adjourned empty handed, but is still holding
discussions.
In Montana, all bets are off after a week of wild politics.
"This will be the last chance," said Dick Brown, president of the
Association of Montana Health Care Providers, noting that when
legislators in his state go home in a few weeks, they will not
return for two years.
"Who knows what happens then," he said.
(Additional reporting by Bill Cotterell in Tallahassee, Fla.;
Editing by David Adams and Andre Grenon)
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