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Popular Medicaid expansion still struggling

In South Dakota, where Medicaid expansion is popular, GOP state policymakers won't let the issue be decided by the voters.
Leonor Cervantes (L) and other protesters gather in the office of Florida State Rep. Manny Diaz as they protest his stance against the expansion of healthcare coverage on September 20, 2013 in Miami, Florida.
Yesterday, Republicans in the state legislature shot down that idea, too.

A South Dakota Committee has defeated a measure that would have asked voters whether the state should expand Medicaid in line with the federal Affordable Care Act. The Senate State Affairs Committee voted 7-2 against the resolution. [...] The measure, sponsored by Democrats, would have asked voters in the next general election if they wanted to expand Medicaid to individuals up to 138 percent of poverty.

The State Affairs Committee voted along party lines -- seven Republicans voted against sending the issue to the public; two Democrats voted for it.
If conservatives are right and the Affordable Care Act is wildly unpopular, especially in "red" states like South Dakota, why not put the issue on the statewide ballot? Because Republicans no doubt saw recent polling showing very strong support for Medicaid expansion in the state.
If the policy were adopted, it would mean health care coverage for nearly 50,000 low-income South Dakotans. Now, those families will be forced to go without.
About 900 miles south, in Arkansas, the state already has a version of Medicaid expansion in place, but the policy is in severe jeopardy.
The New York Times reports this morning:

Last year, the Republicans who control this state's Legislature devised a politically palatable way to expand Medicaid under President Obama's health care law. They won permission to use federal expansion funds to buy private insurance for as many as 250,000 poor people instead of adding them to traditional Medicaid, which conservatives disparage as a broken entitlement program. [...] Facing pressure from conservative challengers in the May primary, several Republicans who supported the plan last year are now considering switching their vote when the Legislature votes to reauthorize its financing, possibly as soon as next week. The defection of just one Republican could kill the program, state officials said.

If GOP state lawmakers kill the policy, as now appears likely, as many as 85,000 low-income Arkansans would lose access to health care. In effect, after months of Republicans complaining about "cancelation notices," GOP officials in Arkansas would cancel thousands of coverage plans on purpose.
Indeed, fights like these are playing out from coast to coast. Medicaid expansion is on track in New Hampshire, but it's dead in Idaho. Arizona's Medicaid expansion has survived a court fight, but Louisiana's efforts are facing pushback from the Koch brothers' political operation.
All told, we're looking at millions of struggling Americans who will fall into a gap -- they would be eligible under Medicaid, but Republican policymakers in their state are rejecting the federal funds and leaving them in the lurch.