Is resistance to Medicaid expansion crumbling?

The lost dollars are whispering ever louder in the ears of Medicaid naysayers.

Two years ago, the U.S. Supreme Court ruled it was up to states to expand Medicaid eligibility under the Affordable Care Act. The decision to do so split mostly along political lines. Blue states such as Massachusetts, California and Minnesota were on board from the beginning.

By contrast, many of the red or "cowboy" states were just as equally opposed, despite the seemingly endless demand within them for healthcare services for the poor. Count Texas and Oklahoma among them, led by ideologically rigid governors Rick Perry and Mary Fallin. The latter happily ignored the authority of her own state Supreme Court earlier this year so she could move forward with what wound up to be a horrendously botched execution.

But then there was Kentucky, Arkansas and Arizona, all of which expanded their Medicaid programs despite being politically conservative states, and the sky did not fall in.

Now we have Wyoming, the actual Cowboy State. As the Los Angeles Times reported in late August, it's moving forward with federal negotiations  to expand its Medicaid program, no longer able to turn the other way as $200 million a year in federal payments--more than $343 per each resident--slide by.

That's just a drop in the bucket compared to the $600 billion the Robert Wood Johnson recently estimated states that bypassed Medicaid expansion were dismissing over the next decade. Or the fact that for every dollar the states spent on expanding Medicaid, they receive $13.41 federal dollars in return.

Pennsylvania recently threw in the towel and came to terms with the feds to expand Medicaid, and at least nine other states are in talks to do the same. Many of them have Republican governors.

Those developments have to be good news for hospitals operating in those states, which not only receive little relief for uncompensated care but also have to swallow cuts in the disproportionate share hospital program. Rural hospitals in South Carolina and Tennessee have been closing their doors. A hospital in Indiana recently shut down its emergency room.

If those red states come to terms on Medicaid expansion, it won't be on quite the same terms as the blue states. Indiana, for example, wants Medicaid enrollees to pay some premiums or lose their coverage for a period of time.

Currently, 27 states have expanded Medicaid. After it becomes even less of a political hot potato after the mid-term elections, expect another half-dozen to hop on board.

The last few states are likely to hold out until the end of the decade. Expect Texas, Oklahoma and Louisiana to be among them. But the tide of history will eventually sweep them with the others. And the nation's hospitals will be grateful for it. - Ron (FierceHealth)