"From Virginia to Texas — a region encompassing the old Confederacy and Civil War border states — Florida's Rick Scott is the only Republican governor to endorse expansion, and he faces opposition from his GOP colleagues in the legislature," Barrow writes. "Tennessee's Bill Haslam, the Deep South's last governor to take a side, added his name to the opposition on Wednesday."
"Many of the citizens who would benefit the most from this live in the reddest of states with the most intense opposition," Drew Altman, president of the Kaiser Family Foundation, told Barrow, who writes: "So why are these states holding out? The short-term calculus seems heavily influenced by politics." With several Republican governors seeking re-election next year or in 2015, "The law remains toxic among Republican primary voters," GOP pollster Whit Ayres told the AP.
Ezra Klein of The Washington Post says states that refuse to expand Medicaid will hurt their rural hospitals because the health-reform law will end "disporportionate share" payments now made to hospitals that depend heavily on Medicaid and Medicare, and those hospitals need the extra volume from Medicaid to make it up. "It’s a classic example of cutting off your nose to spite Obama," Klein writes.
One border state that has voted Republican in the last four presidential elections could still expand Medicaid. Democratic Gov. Steve Beshear of Kentucky has said he will expand the program if the state can afford it, and is nearing a decision. He may be considering a request to use Medicaid money to help buy private insurance for those who aren't poor enough to qualify for the program, as Arkansas is doing, Molly Burchett of Kentucky Health News reports.