美国国家公共电台 NPR With Obamacare Here to Stay, Some States Revive Medicaid Expansion（在线收听）

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The Republicans' failure to repeal the Affordable Care Act opened up an opportunity for advocates wanting to expand Medicaid. They see one last chance to get billions of federal dollars for their states and cover hundreds of thousands of low-income people. But as NPR's Alison Kodjak reports, that effort faces some of the same political and ideological fights that played out in Washington.

ALISON KODJAK, BYLINE: Kansas is overwhelmingly Republican and undeniably conservative. So it was a bit of a surprise last week when both houses of the state's legislature voted by wide margins to expand its Medicaid program.

BARBARA BOLLIER: This been a long time and a hard road.

KODJAK: That's Kansas senator Barbara Bollier. She's a Republican and a doctor. And she's been fighting for years to get her colleagues to agree to open up Medicaid to more low-income Kansans. The expansion is allowed under the Affordable Care Act, also known as Obamacare. Thirty-one states plus Washington, D.C., have expanded their Medicaid programs. But after November's election, that momentum slowed because Republicans in Congress promised to repeal key parts of Obamacare, including Medicaid expansion. Now that the repeal effort appears to be dead in Washington, Bollier says it's time for Kansas to move on.

BOLLIER: We are not taking away the Affordable Care Act. It is the law of the land. We need to live in it and move forward.

KODJAK: She says expanding Medicaid could cover 150,000 people who aren't now eligible. But many Republican lawmakers remain opposed to anything related to Obamacare, like Kansas Senator Ty Masterson, who compared the bill to a broken amusement park ride during last week's debate.

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TY MASTERSON: It's broken. And we're saying we want to go ahead and get on the ride. There's a reason there's nobody in line behind us. Sign's up - out of order. I don't want to be first in that line. I want to get out of that line.

KODJAK: On Thursday, Kansas Governor Sam Brownback vetoed the bill, saying it's too expensive and it allows money to go to what he calls the abortion industry. So expansion supporters are working furiously this weekend to switch a handful of votes in hopes of overriding the veto, perhaps as soon as tomorrow. About 1,200 miles due east from the fight in Wichita is Richmond, Va., where Governor Terry McAuliffe is a Democrat pushing his Republican legislature to expand Medicaid. But so far, they're not buying.

TERRY MCAULIFFE: I have had more excuses out of my Republican general assembly, none of them correct. The most recent argument was - is that this was going to be repealed. Well, now it's not.

KODJAK: McAuliffe says about 400,000 Virginians could be eligible for the expanded Medicaid, and the federal government would send about $2.4 billion a year to the state to cover the cost. But he says lawmakers fear the political fallout of embracing anything related to Obamacare.

MCAULIFFE: But the problem is my legislature is terrified of the Tea Party. That's the only reason they're not voting for it - because they're afraid they'll get taken out in the primary, plain and simple.

KODJAK: But Virginia lawmakers say they just don't trust the federal government will keep paying the Medicaid tab for the long term. So in Virginia, expanding Medicaid is still a long Shot. But up north in Augusta, Maine, expansion may be on a path to approval. That state's Republican Senate and Democratic House have passed Medicaid expansion bills five times. And five times, Governor Paul LePage has vetoed them. Republican Senator Tom Saviello favors Medicaid expansion because it'll help his constituents' health and the local hospital.

TOM SAVIELLO: You know, I'm a Republican. And somebody else is paying taxes to support Medicaid expansion. I want to take those taxes and apply it towards my citizens rather than not expand and send that money out of state.

KODJAK: But with LePage still in charge in Maine, the legislature is handing control to voters. A citizens group has gathered enough signatures to put the question to a referendum.

SAVIELLO: Because we have the citizens petition, we're putting it in the citizens' hands. And I have polling data that I did for the last couple years - 60 percent of the people in Maine want Medicaid expansion. So it's going to happen. It's coming.

KODJAK: With Obamacare repeal delayed if not dead in Washington, these may be just the first states to look at Medicaid expansion and determine it could be a good deal. Alison Kodjak, NPR News, Washington.