Because the individual mandate was upheld by the Supreme Court, Medicaid expansion has become the defining political flash point for Obamacare. In most states the problem will resolve itself as election year rhetoric cools and state-level politicians find themselves staring at the prospect of losing hundreds of millions of dollars in direct federal aid.
In most states, public pressure will mount and opposition will crumble as healthcare providers, advocates and patients bombard the media with heart-wrenching stories about the otherwise preventable pain and suffering inflicted upon their poorest and most vulnerable citizens who can't get Medicaid. Fiscal watchdogs will complain about the money left on the table.
Resistance to Medicaid expansion may hold fast in Texas, Louisiana, and New Jersey, all of which have Republican governors who are expected to consider running for president in 2016.
However, even the most resolute opponent of Obamacare would be hard pressed to reject a windfall of federal dollars, especially as the rest of the nation comes to accept the notion that Obamacare is with us for good.