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In state after state, a gulf is opening between Republican governors willing to expand Medicaid coverage through the Affordable Care Act and Republican members of Congress convinced the law is collapsing and determined to help it fail. In recent months, insurers have increased premiums and deductibles for many policies sold online, and a dozen nonprofit insurance co-ops are shutting down, forcing consumers to seek other coverage. But in Arizona, Arkansas, Indiana, Iowa, Michigan, Nevada, New Jersey, New Mexico and Ohio, Republican governors have expanded Medicaid under the health care law or defended past expansions. In South Dakota, Tennessee and Utah, Republican governors are pressing for wider Medicaid coverage. ... That has created tension with Washington that some lawmakers can no longer ignore. (Pear, 12/27)

Gov. Matt Bevin announced Wednesday he has begun work to transform Kentucky's Medicaid program by 2017. But in the meantime he envisions no major changes in the government health plan that covers nearly 1.3 million Kentuckians. (Yetter and Loftus, 12/30)

As the 2016 session of the Kentucky General Assembly opens, lawmakers say they plan to keep a close eye on changes to the state's Medicaid system proposed by Gov. Matt Bevin, who has said he wants to reshape it along the lines of one operated by Indiana, which requires premiums, co-pays and provides different tiers of coverage. "It's going to be interesting to see how it shakes out," said Rep. David Watkins, a Henderson Democrat and retired physician who serves as co-chairman of the legislature's Medicaid Oversight and Advisory Committee. "We're already at the bottom of the heap here in Kentucky. We don't need to go down any further." ... Senate President Robert Stivers, a Manchester Republican, told the Kentucky Health News last week that lawmakers could enact legislation, but Bevin has the authority to redesign Kentucky's Medicaid program without legislative approval. (Yetter, 1/4)

Don’t expect another bruising fight this year in the Legislature over expanding Medicaid in Florida. But there are still issues to resolve as lawmakers decide how much more the state will have to contribute to the massive federal-state health care program for the poor that already consumes nearly a third of the state’s $79.3 billion budget. ... Florida lawmakers will spend this year’s session discussing ways to keep Medicaid costs under control. They also must determine how much more state money is needed to cover the loss of federal cash for a small Medicaid program that helps cover the cost of uncompensated care provided to the poor through hospitals and other providers. (Sarkissian, 1/3)

Gov. Peter Shumlin says he won't ask the Legislature to raise taxes to pay for an expansion of the Medicaid program. Shumlin says he tried that approach last session and lawmakers rejected it. According to Shumlin, much of the new money that will be needed to balance the Medicaid budget will have to be taken from other agencies of state government. (Kinzel, 12/29)

California officials never anticipated how many people would sign up for state-run health insurance under Obamacare. The state's health plan for the poor, known as Medi-Cal, now covers 12.7 million people, 1 of every 3 Californians. If Medi-Cal were a state of its own, it would be the nation's seventh-biggest by population; its $91-billion budget would be the country's fourth-largest, trailing only those of California, New York and Texas. (Karlamangla, 12/31)

They toil in America’s fast-food restaurants, call centers and retail stores — yet as many as 5 million Americans remain not only poor but also uninsured, despite an array of state and federal policies specifically intended to help them get health care. These people are caught in a health care netherworld. Their employers classify them as part-time workers or independent contractors, therefore avoiding any obligation to provide health care. Their state governments have not expanded Medicaid to include low-wage earners. And government mandates set a standard for “affordable” coverage that is not affordable at all for these families. (O'Donnell and Ungar, 12/28)

[C]ompanies, cities and states are trying to come up with solutions to help ensure the working poor get the health care they need — even in states that haven’t expanded Medicaid. One of those states is Alabama, where the city of Birmingham also raised its minimum wage after labor groups cited the lack of health care for low-income workers. With hourly wages of $10.10 an hour, activists such as LaDarius Hilliard argued that some low-wage workers could at least buy heavily subsidized health insurance on the federal insurance exchange. Meanwhile, Alabama’s Republican governor, Robert Bentley — citing the plight of the working poor — said in November he’s looking at Medicaid expansion after years of resistance although he hasn't made a final decision. Texas has said no to the expansion all along, but Harris County, which includes Houston, offers a taxpayer-funded “Gold Card” insurance program that provides help (Ungar and O'Donnell, 12/28)