The last wall of resistance against Medicaid expansion crumbles

The Obama administration is finally getting tough with states that refuse to expand Medicaid eligibility under the Affordable Care Act (ACA). It is a welcome sight to behold.

The Centers for Medicare & Medicaid Services (CMS) has warned Texas, Florida, Tennessee and Kansas that if they fail to expand Medicaid, they risk losing special funds earmarked specially for doctors and hospitals to treat the indigent.

It's been fun to watch the reaction: Tennessee Gov. Bill Haslam said the tactic seems "awfully heavy-handed," according to The Tennessean. Florida Gov. Rick Scott has not only sued the feds, but the state's Legislature is so out of joint over the issue that its House of Representatives adjourned days earlier than planned to avoid discussing the topic, abandoning a vote on the state's budget to do so. And Texas Gov. Greg Abbott, who is so paranoid about the feds that he recently mobilized the state guard to better monitor its activities, according to NPR, said he is thinking of joining Scott's suit.

At this juncture, five years after the passage of the ACA and two years after it's being implemented on a large scale, the Obama administration has nothing to lose by pressuring those states. The president is a lame duck, the mid-term elections are in the rearview mirror, and public sentiment is beginning to actually warm to the ACA--despite it being exposed to years of right-wing toxic emissions about the perils of allowing your less-fortunate neighbor access to healthcare. 

Nevertheless, Montana, which is not exactly a bastion of left-wingers, just approved Medicaid expansion itself, Kaiser Health News reported. It will be tied to assistance finding low-income residents jobs and job training (whether there are actually enough well-paying and full-time jobs available in the Big Sky State to wean everyone off the Medicaid rolls remains to be seen), but those requirements are so mild that CMS will almost certainly sign off on its proposal.

Now that the number of states that have refused to expand Medicaid has dipped below 20, expect to see more follow suit in short order--including those whose leaders are still foaming at the mouth. Medicaid expansion states now comprise more than a 60 percent supermajority, making those holdouts look more like outliers with every passing day. And data is trickling in showing that those states (and their hospitals) are depriving themselves of billions of dollars for no explicable reasons at all, making their arguments for holding out appear even more specious.

The polling data is also swinging on the issue. Nearly two-thirds of Kansans--including 58 percent of Republicans--say they support Medicare expansion in their state, according to an opinion piece from the Wichita Eagle. What crucial core of voters remains that might be offended by the notion? 

Within two years, I suspect fewer than a half-dozen states will still be on the anti-expansion bandwagon, although an adverse outcome in the King v. Burwell case could impact that, according to Al Jazeera America. And if the Obama administration won't be around to pressure them to see the light of day, I hope the incoming president devises new ways to keep them feeling the heat. - Ron (@FierceHealth)