As the campaign rhetoric cools and the Patient Protection and Affordable Care Act settles in, there is speculation that governors who've been adamantly resistant to Medicaid expansion under the law's sweeping reforms, may find a way to drop their objections.
"Fall rhetoric does not always match with winter activity," says Ceci Connolly, managing director of the Health Research Institute at PwC. "I would not be surprised if we see more states now taking a second look at the possible Medicaid expansion, in part, because they have been hearing from providers in their states who are worried about uncompensated care costs."
The Supreme Court in its landmark 5-4 ruling on June 28 that upheld key provisions of PPACA also struck down as overly coercive the federal government's demands that states expand their Medicaid rolls.
Resistance to expanding the rolls, particularly among Republican governors, reached a fevered pitch in July when Texas Gov. Rick Perry sent a letter to Health and Human Services Secretary Kathleen Sebelius. Perry, who was running for president at the time, explained that the Lone Star State stood "proudly with the growing chorus of governors who reject the PPACA power grab.... Neither a state exchange nor the expansion of Medicaid under the Orwellian named PPACA would result in better patient protection or in more affordable care."