The Affordable Care Act is still the law of the land. A viable repeal-and-replace effort may or may not be forthcoming in Congress, but until one materializes the provisions of the ACA remain in effect, and the Trump administration is bound by law to enforce them.
But the administration has made little secret of the fact that it does not want to enforce them—especially not the pieces that will tend to erode political support for repeal. Many of the 19 Republican-led states that have resisted the ACA’s expansion of Medicaid to low-income healthy adults, struggling with public-health issues like the opioid crisis and enticed by ample federal funding, are now reconsidering their involvement. And the Trump White House appears desperate to do what it can to stop them.
Most states waited to see some kind of resolution to the ongoing congressional debate over the American Health Care Act, the Republican Obamacare replacement, but inter-caucus dithering and the lengthening odds of any reform passing the Senate have spurred some states to action. So far, that action has been unkind to Medicaid expansion proponents. In mid-March, the Idaho Senate rejected a Democratic plan to extend Medicaid coverage for some of the sickest uninsured people. In one of the most conservative states in the country, in early April, the Kansas House fell just three votes short of overriding a veto by Governor Sam Brownback of the legislature’s Medicaid expansion plan. An expansion plan by Virginia Governor Terry McAuliffe also failed before the state legislature in April, and despite political pressure to act, Georgia and South Dakota both failed to advance Medicaid expansion plans through their legislatures.