The Affordable Care Act narrowly escaped a judicial decision that would have shrunk its reach Thursday when the Supreme Court ruled the IRS could continue distributing insurance subsidies nationwide. Now, with the law no longer under an immediate meaningful threat of repeal, some are looking to stretch Obamacare further.
Specifically, governors in several states are renewing their push to expand Medicaid, hoping to bring the federal low-income health insurance program to more of their state's residents.
"It is ... a clear sign that now is the time to drop cynical efforts to prevent families from accessing care that will make their lives better," Virginia Democratic Gov. Terry McAuliffe wrote in a statement. "With this issue decided, I hope we can now put partisan politics aside and help 400,000 Virginians get access to health care by bringing our taxpayer dollars home to close the coverage gap."
Alaska Gov. Bill Walker, an independent, was even more blunt: "Now it's important that we continue to work toward Medicaid expansion, so more Alaskans can receive the health coverage they need."
And Missouri Democratic Gov. Jay Nixon said: "It is important to note that there are hundreds of thousands more Missourians who continue to be denied access to affordable health care due to the Missouri legislature's inaction on Medicaid."
Initially, the Affordable Care Act included a universal Medicaid expansion. But in its 2012 ruling, the Supreme Court ruled the federal government was overstepping its power and the decision lies with states. Currently, 30 states including D.C. have opted into expansion and 21 have not.
The Obama administration's victory serves as further evidence that the law is here to stay. Its supporters say it's time for all states to embrace the law, including Medicaid expansion. Waiting for the Supreme Court's decision, they say, is no longer an excuse for balking.
However, many of the same forces that blocked states from expanding the first time around are still present: GOP-controlled legislatures and conservative groups worried about "expanding Obamacare" and expanding social welfare programs, and worried that the federal government will eventually stop footing the bill. The law allowed for the federal government to pay for 100 percent of expansion until the end of 2016. After that, the rate will steadily drop to 90 percent by 2020.
"Governor McAuliffe must not be very informed with the King v. Burwell case if he thinks yesterday's ruling is an excuse to make another bid at expanding the broken program," wrote Ben Knotts, Virginia deputy state director of Americans For Prosperity, in an email statement. "The opinion of the court hasn't changed the opinion of the Virginia people or altered Virginia's right to reject Obamacare's Medicaid expansion."
Whether or not the governors succeed in their push to expand the program, it's a far different national conversation than the one many were poised for in the run-up to the Supreme Court's King v. Burwell decision.
Had the Court found in favor of the law's conservative challengers, it would have blocked the IRS from distributing insurance subsidies to more than 6 million people across the 34 states that use the federal insurance exchange. Conservatives pushing the challenge had hoped that by invalidating the subsidies, they could extract concessions from President Obama to repeal or change major parts of the law. Several legislative plans proposed by Republicans extended subsidies until after the 2016 election while repealing parts of the law such as the individual mandate, the employer mandate, and essential health benefits.
Caitlin Owens is a health care reporter at National Journal. Her work has previously appeared in the Los Angeles Times, The News & Observer and The Charlotte Observer. She is a graduate of the University of North Carolina at Chapel Hill.