More Republicans tried to expand state Medicaid programs this year, but their colleagues haven't bitten.
Legislators in Tennessee, Utah, Idaho and Wyoming have rejected alternative plans proposed by Republican governors, and some GOP legislators in Florida and Montana are struggling to advance alternate plans as well.
These states are among the 22 that have rejected Obamacare's offer of expanded Medicaid, and the federal funds that accompany it. The health care law allows for those earning up to 133 percent of the federal poverty level to enroll in Medicaid, but the Supreme Court has said states can opt out of the expansion if they want to — and many Republican-led states have done so.
Now that the legislative season is starting to wrap up with little progress, some last-ditch efforts are being made.
A Tennessee House committee is scheduled on Wednesday to take up a revamped version of Gov. Bill Haslam's plan. Legislators rejected it in February but are now reconsidering it after making some tweaks intended to pacify conservatives.
Still, the plan isn't likely to pass, and that's leaving health care advocates in the state fuming.
"If they throw away four and a half billion dollars because they hate Obama, that's a rather sorry tale for the leadership and the legislature, because we've got bipartisan support," said Walter Davis, executive director for the Tennessee Health Care Campaign.
Davis sees the rejection of Haslam's plan — which is more market-oriented and puts the extra dollars toward private plans instead of traditional Medicaid — as little more than political posturing by conservatives. He's doubtful it will pass until President Obama has left office.
"There are a lot of rumors that we're not going to vote until Obama's out [of office]," Davis said. "It's Obamacare and to hell with it."
The Tennessee plan is similar to one proposed by Utah Gov. Gary Herbert, which also hit roadblocks. By mid-March, Herbert and legislative leaders admitted they were unable to reach a deal and instead formed a working group that will try to hammer out a compromise by the end of July.
It's House Republicans who are putting up objections in Utah. They like how Herbert's plan would enroll the newly-eligible poor in private plans instead of traditional Medicaid, but they want the state to cover a larger portion of the cost, saying the extra federal dollars could always be rescinded.
It's a similar story in Wyoming — where the Senate rejected Gov. Matt Mead's expansion plan — and in Idaho, where committees held hearings on a plan put forward by Gov. Butch Otter but legislation was never proposed. Last week the Idaho House speaker said there wasn't enough support among members to move ahead.
The ongoing disputes in these states reflect how divided Republicans remain on how to respond to one of the Affordable Care Act's main components.
Some GOP governors including New Jersey Gov. Chris Christie have accepted the expansion, but other Republicans have insisted the federal government might suddenly retract the extra Medicaid dollars, leaving states with the bill.
Still other governors have tried to fashion the expanded programs in ways more attractive to conservatives. Haslam, Herbert, Mead and Otter all started off the year urging their Republican-led legislatures to consider alternative plans and similar efforts led by GOP legislators are underway in Montana and Florida.
Democrats and supporters of expansion view the Republican resistance as little more than a show of disdain towards President Obama's healthcare law, which they oppose. Still, some see progress being made.
Matt Salo, who leads the National Association of Medicaid Directors, said the stalemates this year are "more of a road bump in a long journey."
"Governors and Medicaid directors are working really hard to find the sweet spot of an approach that addresses their individual state's circumstances, can get approved by both the White House and their statehouse," he said. "The push for a solution is not over by any stretch, and they're definitely closer in many states than they were six months or a year ago."