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Now to a key part of the Affordable Care Act.
GOVERNOR EARL RAY TOMBLIN: We have weighed the options and believe expanding Medicaid is the best choice for West Virginia.
(SOUNDBITE OF APPLAUSE AND CHEERING)
CORNISH: That's West Virginia Governor Earl Ray Tomblin. With that announcement last week, his state became one of 20 so far to expand health coverage for the poor. But Obamacare makes that optional for the states and it looks like at least half of the states will opt not to do it. NPR's Greg Allen is in a state where there's been a tussle over that decision, Florida.
GREG ALLEN, BYLINE: As state legislatures around the country wrap up their spring sessions, one of the main issues has been whether to expand Medicaid. At Florida's Capitol building in Tallahassee, the lobbying in favor of expansion was intense.
(SOUNDBITE OF SINGING)
ALLEN: A hundred nurses singing "Expand Medicaid tomorrow." They were from the state's largest public hospital, Miami's Jackson Memorial. The head of the hospital's union local, Martha Baker, says expanding Medicaid would provide coverage to a million or more Floridians who currently don't have it.
MARTHA BAKER: The poorest of the poor are insured right now with Medicaid. This would hit that kind of middle ground of those working poor, we call them.
ALLEN: In Florida, Republican Governor Rick Scott, a leading opponent of the president's health care overhaul, stunned many this year when he reversed course and said he supported expanding Medicaid. But despite the governor's change of heart and lobbying by hospitals and business groups, some Republican lawmakers disagreed.
Last week, the legislature adjourned without taking action to expand Medicaid. Here's Governor Scott.
GOVERNOR RICK SCOTT: I've supported taking care of Floridians that don't have access to care, while the federal government's going to pay 100 percent, but the legislature said no.
ALLEN: As Scott said, a major reason why he decided to support Medicaid expansion is that for the first three years, it would cost the state almost nothing and would pump an estimated $51 billion into Florida's health care economy. Elsewhere in the country, the windfall of federal money and the opportunity to provide health care for low-income residents also appealed to other Republican governors, such as Michigan's Rick Snyder and Ohio's John Kasich.
But like Scott, those governors are also being stymied by opposition from within their own party. In Florida, Republican House Speaker Will Weatherford said he opposed it because of what he called the federal government's all-or-nothing approach to Medicaid.
STATE REPRESENTATIVE WILL WEATHERFORD: Washington said you have to take Medicaid for a million people or 900,000 people. You can't target the money. You can't focus the dollars. You can't invest in private sector plans. The truth is there's been no signal from Washington, D.C. that there's flexibility to this money.
REPRESENTATIVE DEBBIE WASSERMAN SCHULTZ: Their real reason is that they simply don't support the Affordable Care Act.
ALLEN: Florida Democratic Congresswoman Debbie Wasserman Schultz rejects Weatherford's explanation. Wasserman Schultz, who's also head of the Democratic National Committee, was in Tallahassee for the final days of the legislative session. She says the rejection by Florida's House wasn't about a lack of flexibility by the federal government but about Tea Party ideology.
SCHULTZ: There has been a tremendous amount of flexibility, particularly when it comes to health care waivers and opportunities to do things differently. The Obama administration has indicated a willingness and an interest in working with states.
ALLEN: As an example, Wasserman Schultz points to Arkansas. Officials there are working with the Obama administration on a plan that would expand coverage for low-income residents by channeling them not into Medicaid, but into private managed care plans. But for now, Florida becomes one of 26 states that appear to be moving to reject Medicaid expansion.
Democrats are urging Governor Scott to call the legislature back to revisit the issue in a special session. That appears unlikely. But Caroline Pearson, with Avalere Health, a consulting group, says those in favor of expanding Medicaid shouldn't give up hope. The program, she says, ran into similar resistance when it was first created in 1965.
CAROLINE PEARSON: We did not have all states join the program in initial years, but eventually each of them did opt in. And I think you will see slow movement towards more states expanding as time goes on.
ALLEN: Florida joined Medicaid in 1970. The last state, Arizona, didn't opt in until 1982. Greg Allen, NPR News, Miami.
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