States Holding Out on Medicaid Expansion Are Beginning to Crack

New Hampshire could be the first of many to sign on.

As Planned Parenthood supporters rallied outside Florida Gov. Rick Scott's office earlier this week, state Sen. Arthenia Joyner lashed out at opponents of Medicaid expansion. Standing at a wooden lectern, surrounded by scores of women, she crossed party lines to stump for a bill that would increase the number of poor Floridians covered by Medicaid.

"We need to pass Sen. Garcia's bill," the Democrat told the gathered masses, referring to a proposal introduced by her Republican colleague Rene Garcia. "It was good enough for the speaker's family," she added, referring to a time when Republican House Speaker Will Weatherford's family had relied on medical assistance to pay for his brother's cancer treatments. "By golly, it's good enough for all of the families of Florida." That story, first reported in The Tampa Tribune, is just the latest sign that Obamacare's Medicaid expansion effort has reached a tipping point.

With 25 states and the District of Columbia opting in to Medicaid under the Affordable Care Act and another six in limbo, the tumult in a handful of holdout states is increasing. The White House hopes unrest in states like Florida, New Hampshire, Nebraska, and Maine will help turn the fight decidedly in their favor. And there's good reason to think that's happening.

New Hampshire, a state that was noncommittal on Medicaid expansion, is now on the brink of expanding coverage to approximately 50,000 poor residents. The Republican-controlled Senate voted to pass a state-modified version of expansion earlier this month. And, on Tuesday, a House panel endorsed the motion. The Democratic-controlled House is expected to pass the bill in a vote next week.

In Virginia, Democratic Gov. Terry McAuliffe has been fighting for Medicaid expansion since he was elected in November (the Republican-led House is opposed). Tensions came to a head this weekend when several hundred demonstrators gathered outside the state Capitol in Richmond to rally for Medicaid expansion, carrying signs that read "We need Medicaid expansion now" and "Get sick, go broke, unacceptable!"

In Pennsylvania, Republican Gov. Tom Corbett had originally proposed a modified version of the program, tying in a controversial requirement that madated those working fewer than 20 hours per week participate in a job-training program to qualify for coverage. The governor has since submitted a softer proposal that "restores some benefits" and drops the work-search requirement in favor of a voluntary pilot program. That plan, currently under review by the federal government, is unlikely to win support from Washington, given Corbett's stipulations.

Representatives for Utah Gov. Gary Herbert traveled to D.C. this week to discuss Medicaid expansion efforts with administration officials. The governor, who initially refrained from opting in, in January vowed to take action on Medicaid expansion, saying while he opposes President Obama's health care law, the state has an obligation to help its poor. But his proposal, a "block grant" option that would use federal dollars to cover the poor in private plans, failed to win the support of Republican leaders in the House and Senate. The Salt Lake Tribune reports that "though he lacks the backing of the Legislature, lawmakers haven't tied his hands." Herbert advisers meeting with the Obama administration this week include Wesley Smith, director of state and federal relations; David Patton, head of the state's Department of Health; and staff members from the Health Department's Medicaid office, according to the Deseret News.

Movement in Missouri has been stymied by a standoff between Democratic Gov. Jay Nixon, an advocate of expansion, and the state's GOP Legislature. But even there, the dynamic is starting to shift. KCUR.org reported Tuesday that Missouri politicians "might be inching toward middle ground that would expand Medicaid eligibility while reforming the safety-net program to encourage recipients to work," according to two key participants in the talks. Legislation pending in the House is scheduled for a hearing on on March 25.

These stories of incremental progress can also be found in states that have rejected Medicaid expansion outright, a decision states may change at any time. In Nebraska, the Legislature is battling it out over expansion with onlookers like Democratic gubernatorial candidate Chuck Hassebrook,who is urging state lawmakers to pass a bill that would expand coverage to some 54,000 uninsured Nebraskans. Small protests have begun in South Carolina, with demonstrators gathering outside the State House parking garage weekly to protest the state's decision not to accept federal Medicaid money. (On Tuesday, the 16 protesters were sent to court for obstructing traffic.) And in Maine, state lawmakers have backed a compromise on Medicaid expansion but fell just short of the veto-proof majority needed to get it past Republican Gov. Paul LePage. (Maine's version of the bill would expand the state Medicaid program to provide health care coverage for 60,000 to 70,000 individuals earning just over $15,856 a year.)

No doubt many of these bills will continue to be stymied for some time — virtually all of them by people with the means not to rely on such insurance. And plenty of conservative critics will continue to rage that Medicaid expansion is "sinful" and that the Affordable Care Act is "a plot to destroy the family." But it's looking increasingly like time is not on their side.