The Four GOP States That Have Officially Adopted Obamacare

President Barack Obama gestures before he speaks about health care reform and the Affordable Care Act in the East Room at the White House in Washington, Thursday, July 18, 2013. (AP Photo/Charles Dharapak)
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As states gear up to implement Obamacare, a total of four Republican-governed states have officially enacted legislation adopting its Medicaid expansion, a core component of the law that is projected to cover millions of uninsured Americans starting Jan. 1, 2014.

An additional three Republican-led states may adopt the expansion in the coming months. Here are the four GOP states that already have overcome the conservative activists who have fought hard to reject the Medicaid expansion on the state level.

North Dakota

On April 16, North Dakota Gov. Jack Dalrymple (R) signed legislation to expand Medicaid for about 20,000 new state residents.

The bill passed the state legislature with little fanfare, but not without some Republican opposition. As the Associated Press reported at the time, “GOP lawmakers in both chambers said they felt forced to vote to expand Medicaid because of the added to costs residents if they didn’t.”


On June 17, Arizona Gov. Jan Brewer (R) enacted the Medicaid expansion for nearly 300,000 Arizonans, after an all-out political brawl with her own party in the state legislature.

She forced them to buckle after an aggressive pressure campaign, threatening to oust GOP leaders and vetoing bills they sent her until they expanded the low-income health care program.

“I knew I had not chosen the easy path,” Brewer said upon signing the bill. “But I learned a long time ago that what is easy and what is right are rarely the same. Well, today I know in my heart that we have made the right choice.”

Conservative opponents dubbed the move “Obrewercare.”


On June 20, Iowa Gov. Terry Branstad (R) enacted legislation accepting the Medicaid expansion to cover an estimated 150,000 state residents. Careful not to describe it as Obamacare, the governor described the move as an “Iowa solution” to Medicaid.

“The plan that we’re signing today increases access to high-quality modern health care,” he said. “We even believe what we’re doing could be a prototype that could be copied by other states.”

As the AP explains, Iowa’s plan took the expansion in a slightly different direction, accepted the federal Medicaid funds under Obamacare to establish a new state-based program to cover the additional residents. State officials said it posed some challenges.

New Jersey

On June 28, New Jersey Gov. Chris Christie (R) signed into law a state budget that extendd the Medicaid expansion to roughly 104,000 residents of his state.

But in a bit of political kabuki mixed with an attempt to make good on a separate promise, the rumored 2016 presidential hopeful simultaneously vetoed a standalone Democratic bill making the expansion permanent. Christie said he may support reversing the move in the future if the federal government did not come through with the promised funds.

“Working together, we were able to put the people of New Jersey first and pass this budget early,” Christie said after he signed the bill.

(Democratic-led states have adopted the expansion and some other Republican governors are trying to push their legislatures to accept it. Kaiser Family Foundation has more details on where each state stands on the Medicaid expansion.)

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