How many states are really opting in?

The devil's in the details

Dan DiamondThis is adapted from a column in the Daily Briefing's sister publication, California Healthline.

Dan Diamond, Managing Editor

Same story, different week: A governor who opposed the Affordable Care Act changes course and announces plans to opt into the Medicaid expansion.

Supporters of the ACA rejoice, conservatives grumble, and a new number gets tacked on the board—24 states opting in, after Chris Christie's announcement on Tuesday.

Yet there's more to the story than governors' speeches. In at least eight of those states, lawmakers are warning that they may not go along with expansion plans.

Those legislative logjams—and what governors need to do to circumvent them—vary state by state, but the fights are falling out along party lines.

In Missouri, two GOP-led House committees this week voted down Medicaid expansion plans, despite Democrat Gov. Jay Nixon's pledge to opt into the measure last year. Republican lawmakers in Arkansas, Montana and Washington have similarly been skeptical of their Democratic governors' expansion positions. Meanwhile, four GOP governors who have backed the expansion are having difficulty corralling members of their own party.

"All the states are different," Matt Salo, executive director of the National Association of Medicaid Directors, told me. "But for all intents and purposes, you need the executive and legislative branches to agree."

GOP legislatures are balking over risk, cost

That's why we've adjusted our tracker of where the states stand, to more prominently reflect governors' pledges.

Where does your state stand on the Medicaid expansion? Click to expand either a quick-to-scan graphic or an interactive graphic. (Note: interactive graphic may not be optimized for mobile devices.)

Specifically, there's still work to be done before GOP-controlled legislatures in Arizona, Florida, Michigan, and Ohio formally agree to move ahead on authorizing the Medicaid expansion.

In the meantime, governors who want to expand Medicaid can make provisional arrangements to avoid last-minute scrambling, according to Salo. For example, they can work with vendors to have systems that are ready to operate under the expansion's expanded eligibility requirements if necessary, should the state move to opt in after all.

Read the rest of the column here.

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