Virginia and two other red states, Ohio and Michigan, are all still working to expand Medicaid next year.
Three more large conservative states signing onto that key provision of Obamacare would be a significant win for the White House. Since the U.S. Supreme Court made the Medicaid expansion optional last year, most GOP-led statehouses -- with a few notable exceptions, such as Gov. Chris Christie in New Jersey and Gov. Jan Brewer in Arizona, who threatened to veto every bill that crossed her desk unless the legislature agreed to expansion -- have turned down the deal.
In Virginia, the onus for expansion has shifted from Gov. Bob McDonnell (R) to the 10-member legislative panel. Earlier this year, the Republican-led General Assembly passed a bill that would allow for the expansion if the Medicaid program could be made more cost-efficient. The panel is considering various reforms, such as moving to more managed care, to make that happen.
A majority of the panel must vote for expansion for it to move forward. Public hearings are expected to begin this fall. About 400,000 low-income Virginians would be insured under the expansion, and the state would receive more than $20 billion in federal funding over the next decade.
In Ohio, Gov. John Kasich had endorsed Medicaid expansion earlier this year, but his plan was initially blocked by the GOP-led legislature, which cited cost concerns. A bill that included a spending cap for Medicaid in tandem with the expansion was then introduced last month by Democratic state Sen. Capri Carafo and taken up by a Senate subcommittee. That subcommittee received a report last week that the state would save $200 million in 2014 under the proposal, according to the Columbus Dispatch. If Ohio expanded Medicaid, rough 270,000 low-income residents would be insured. Kasich has yet to take a position on the new bill.
In Michigan, a state Senate committee unanimously passed a Medicaid expansion bill, along with two alternative proposals, at the end of the July. The GOP legislature is expected to take up the legislation when it reconvenes on Aug. 27. Republican Gov. Rick Snyder has said that he supports the expansion, and a bill has already cleared the House. More than 400,000 Michiganders would be insured if Medicaid were expanded.
The Congressional Budget Office estimated after the Court's decision that three million people would be left uninsured because of states opting out of the expansion.
The states have their own incentive for scrambling to agree to the proposal before the year is out. The law requires the federal government to cover 100 percent of the expansion's costs over the first three years (and never less than 90 percent after that). If states fail to expand in 2014, they miss one year of the 100 percent funding.
A common concern cited by GOP lawmakers is that the feds would renege on that promised funding, but those concerns have been largely dismissed by independent analysts. There is no precedent, they say, for the federal government to back out of such a significant funding commitment.
A handful of other red states, Indiana and Tennessee, were open to Medicaid expansion this year but ran out of time before their legislative session expired, according to the Kaiser Family Foundation. The Democratic New Hampshire legislature is also still considering an expansion bill; 60,000 would be insured under expansion in that state.
An expansion bill in the Republican-controlled Pennsylvania legislature passed the Senate, but died in the House before the legislature's summer recess. Democrats, who were joined by some Republicans in the Senate, have pledged to bring the issue up again when the General Assembly reconvenes in September.
Republican Gov. Tom Corbett has said he would reject the expansion unless the Obama administration allowed the state to make significant changes to the program. Up to 800,000 low-income Pennsylvanians would be insured if the state agreed to the expansion.