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Dylan Scott

Dylan Scott is a reporter for Talking Points Memo. He previously reported for Governing magazine in Washington, D.C., and the Las Vegas Sun. His work has been recognized with a 2013 American Society of Business Publication Editors award for Best Feature Series and a 2010 Associated Press Society of Ohio award for Best Investigative Reporting. He can be reached at dylan@talkingpointsmemo.com.

Articles by Dylan

Going into 2014, the United States is split down the middle: 25 states (plus Washington, D.C.) have expanded Medicaid under the Affordable Care Act, and 25 states have not.

Those 25 non-expanding states have left five million people below the poverty line uncovered under the health care reform law, but the White House isn't giving up the fight. Administration officials is actively stumping for expansion, holding conference calls with local officials and reporters and attending advocacy events in 11 of the non-expanding states since the beginning of November.

They think they've got quite a pitch. The federal government would cover 100 percent of the costs through 2016 and never less than 90 percent after that. That deal has already won over some GOP governors, and Obamacare supporters hope it will convince more. That's the leverage the administration and others plan to wield against skeptical state officials.

"I'm not sure there's a very good case for state legislators or governors to explain to people why they oppose Medicaid expansion," White House Deputy Press Secretary Josh Earnest said in response to a question from TPM during a Monday conference call. "It's unfortunate when the stakes are this high, when we're talking about giving people access to quality, affordable health insurance that there are still some politicians who would allow politics to get in the way. That is a tough case to make publicly."

Community organizations and lobbying groups for the medical industry have pledged to push state legislatures when they reconvene in the next year. For their biggest prize -- Texas -- they'll have to wait until lawmakers come back in 2015.

But the battle for many of the other states will begin in the new year. Here's a look at five states among the most likely to reverse course and expand Medicaid in the near future.

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The Obama administration has approved Iowa's alternative plan for expanding Medicaid under Obamacare -- but with one important tweak, which state officials will have to sign off on.

The approval was first reported by the Washington Post. A spokesman for Gov. Terry Branstad (R), who proposed the alternative plan, did not immediately respond to a request for comment.

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Several Obamacare advocates told the Los Angeles Times that they've effectively given up relying on the White House for support in reaching out to people about the law and enrolling them in health coverage.

Their vocal frustrations speak to the rift that has grown between the administration and the advocacy community since the botched rollout of HealthCare.gov.

"The refrain we most often hear is: 'Where is the administration?'" M. Ryan Barker, vice president of the Missouri Foundation for Health, which has been working to support implementation in that state, told the newspaper. "It is very frustrating."

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The emerging deal on food stamp spending, part of the House and Senate's ongoing negotiations over the farm bill, would include dollar savings, but would not kick anybody off the program -- a far cry from the bill passed by the House GOP this fall.

The framework of the deal is a dramatic comedown for Republicans, especially in the House, which already passed $40 billion in cuts to the food stamp program in September. The total cuts in the new deal would likely come in less than $10 billion -- Roll Call reported $8 billion as a possible figure Monday. It's a slight come-up for Senate Democrats, who passed a bill with $4 billion in cuts in the summer. The bulk of the spending cuts would come from an administrative fix, according to sources familiar with the talks.

But importantly for Democrats, no one would be removed from the program's rolls in the deal being finalized in the talks, being led by Senate Agriculture Chair Debbie Stabenow (D-MI) and House Agriculture Chair Frank Lucas (R-OK). The House-passed bill would have resulted in 3.6 million people losing food stamp benefits, according to outside estimates.

Specifics are still being ironed out, and the hope is that the committee will meet this week. Assuming that happens, the Senate could pass the bill before the end of the year and the House will follow suit when it returns in January.

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U.S. Sen. Lindsey Graham (R-SC) announced Monday that he would not use his federally-funded employer subsidy to pay for health insurance under Obamacare.

Members of Congress are required to purchase insurance through the law's insurance marketplaces, but the federal government had ruled that they could still use their government-funded employer contribution to pay for it. Graham said Monday he would decline the contribution, which his office said would have covered about 75 percent of the costs.

“I don’t think Members of Congress should get a special deal,” Graham said in a statement. “Obamacare is being pushed on the American people and we should live under it just like everyone else.”

With HealthCare.gov working better and the first deadline to sign up for health coverage that starts in January approaching, Obamacare's so-called navigators -- the people and organizations receiving federal funds to help people enroll -- are seeing more and more people come through the doors and out to their events.

Navigators are community organizations, higher education institutions and government agencies. They keep offices and phone hot lines open and go out to community events, handing out flyers and giving presentations so people know how they can get insurance under the health care reform law. If somebody needs help navigating the insurance websites, they provide it. And with HealthCare.gov finally functioning, this has been their busiest time since the Oct. 1 launch.

But in 25 states, that robust interest has a downside: Navigators are forced to tell more and more people that they probably won't be able to get covered because their states, all of which had a GOP-controlled legislative chamber or governor, have refused to expand Medicaid. Lynne Thorp, who is overseeing the University of South Florida's navigator program in that state, told TPM that about one in four people who contact her team fall into that Medicaid gap.

"Those are hardest phone calls because it doesn't make any sense to them," Thorp said. "We have to explain that they fall into this gap where this program can't assist them."

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One of the outstanding issues for HealthCare.gov to resolve is bad or missing data being sent to insurers. But according to a new report, those problems are being fixed, too.

The New Republic's Jonathan Cohn cites an "administration official" saying that the error rate for the data files being sent to insurers had dropped from one in four in October to one in 10 currently. Insurance companies have complained on numerous occasions that they were receiving incorrect information from the site or no information at all.

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Rick Santorum said Thursday that Nelson Mandela had fought against "some great injustice" -- apartheid -- just as Republicans are fighting against the great injustice of Obamacare.

“He was fighting against some great injustice, and I would make the argument that we have a great injustice going on right now in this country with an ever-increasing size of government that is taking over and controlling people’s lives -- and Obamacare is front and center in that,” Santorum said Thursday in an interview with Bill O'Reilly on Fox News.

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Jane Orient, a physician in Tucson, Ariz., says she's never accepted a dollar of third-party medical payments, whether from a government program or a private insurance company. She has a "philosophical and ethical" opposition to the U.S. health care infrastructure, and she's put it into practice for more than 20 years.

But with Obamacare set to take full effect in January, Orient says more and more physicians are joining with her in opting out of a payment system that she describes as co-opted by "insurance cartels" and the nanny state.

Orient is the executive director of the American Association of Physicians and Surgeons, a free-market group that claims 4,000 members nationwide, including Sen. Rand Paul (R-KY). Paul himself hasn't endorsed physicians pulling out of the third-party system, but he has said that if a "right to health care" is invoked, then doctors could be conscripted against their will.

"It means you believe in slavery," Paul said in a clip from a Senate committee hearing posted by the AAPS YouTube account.

More than half of AAPS members have stopped accepting Medicaid payments, Orient says, though she stresses that they'll still see patients if they either pay for themselves or come to a free charity clinic. A smaller number of her membership is also bucking the private insurance industry, asking for direct payments from customers and telling them to seek reimbursements from their insurers on their own.

They see themselves as the front lines in the fight against a "plan ... to destroy the current infrastructure," as Orient put it in a recent interview with TPM. Winning that fight starts with convincing their peers and patients to break away from the system set up under the health care reform law.

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Enrollment on HealthCare.gov continued its upward swing this Tuesday, according to a report by the Washington Post.

Tuesday's enrollment was 27,000, the Post reported, citing "internal figures." As TPM reported Wednesday, enrollment on Sunday and Monday -- the first two days after the Obama administration declared the federal website fixed -- came in at 29,000.

That brings the three-day December total to roughly 56,000. Enrollment in all of October was less than 27,000 through HealthCare.gov.

Official November figures are expected to be released by the middle of December.

TPMLivewire