The Obama administration has agreed in concept to Utah's novel alternative to expanding Medicaid, including the notion that able-bodied people who get insurance subsidies should accept the state's help with finding work, Gov. Gary Herbert said late Tuesday. The governor said after a meeting with Sylvia Burwell, secretary of the Department of Health and Human Services, that a final agreement is two or three weeks away.
Two weeks ago, Pennsylvania became the 27th state to accept Medicaid expansion through the Affordable Care Act. According to the Salt Lake Tribune, it looks like Utah is poised to become the 28th.
Note, HHS didn't accept each of the provisions in Utah's proposal, and as Joan McCarter noted, Health Department director was cautious about saying this is a done deal. That said, that same state official called the recent progress a "breakthrough," and the governor said the Obama administration agreed with enough of the Utah plan to call this "a win, win, win all the way around."
Barring an unexpected hiccup, the policy will move forward, bring Medicaid coverage to as many as 111,000 low-income Utahns. This would also make Gary Herbert the 11th Republican governor to accept Medicaid expansion through "Obamacare."
He won't be the last. Tennessee Gov. Bill Haslam (R) has said he expects to follow suit in the coming weeks, and ruby-red Wyoming generally resists any voluntary federal program, but it, too, is starting to come around on Medicaid expansion.
And depending on some key gubernatorial races this year, the number of Medicaid-expansion states may jump even higher very soon -- depending on how many competitive Democrats prevail.
Let's not forget that there are Democratic gubernatorial candidates in Florida, Georgia, Kansas, Maine, and Wisconsin, each of whom support Medicaid expansion, and each of whom stand a reasonably good chance of winning in November.
In case it's not obvious, if the politics of health care made "Obamacare" as toxic as conservatives claimed, these candidates wouldn't be running on this as a key part of their platform. And therein lies the broader point: the politics of this debate are changing.
Even Senate Minority Leader Mitch McConnell (R-Ky.), whose hatred for the Affordable Care Act knows no bounds, recently conceded that Medicaid expansion is almost certain to remain in place indefinitely.
The pressure on the holdout states, mostly in the deep South and Plains states, which refuse to consider the ACA policy out of partisan spite, will likely be unsustainable in the near future.