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Ohio Governor John Kasich speaks during the CERAWEEK global energy conference in Houston March 7, 2012.  REUTERS/Donna W. Carson    (UNITED STATES - Tags: BUSINESS ENERGY HEADSHOT POLITICS) - RTR2Z07W
Gov. John Kasich is going to have to turn in his GOP identification card.
Right now, the largest growth area for new patients under Obamacare is in Medicaid in the states that to expand the program under the law. These are both people who were previously uninsured and ineligible for Medicaid because of their income, and people who were previously eligible but didn't know it and have been brought into the system thanks to the outreach programs done under the law.

As of now, 25 states and the District of Columbia are using the Medicaid expansion funds, and that includes some Republican-led states (which all the same tend purple).

"I'm concerned about the fact there seems to be a war on the poor," Kasich recently told the New York Times, explaining his willingness to expand Medicaid and adopt other improvements to the social safety net. "That if you're poor, somehow you're shiftless and lazy."

In order to adopt the Medicaid expansion for next year, Kasich had to bypass the Republican-led legislature in his state. He turned to the seven-member state Controlling Board for approval of the plan, a move that dozens of state legislators condemned. Six state House Republicans and two anti-abortion rights groups have, in fact, filed a lawsuit against the move, arguing the board has to carry out the "legislative intent" of the General Assembly.

Another Republican governor, Tom Corbett of Pennsylvania, has put forward a plan called "Healthy Pennsylvania" that would accept federal funding to expand Medicaid while making some adjustments. Corbett's version of the program would use the federal funding to help newly-eligible Medicaid recipients buy private insurance on the new Obamacare marketplace. The governor is also calling for job training and job search requirements for all working-age Medicaid beneficiaries.

The job search requirements in Corbett's plan could be a poison pill for the administration, which would have to provide a waiver to allow the program to go forward. But a waiver that would privatize Medicaid has been approved for Arkansas. Next week, New Hampshire's legislature will convene in special session to consider the expansion. There isn't a deadline for Medicaid expansion: States can accept the additional funding at any time. The 100 percent federal funding for it, however, only lasts through 2016. After that it starts slowly phasing down the match until 2020 (and for all subsequent years), when it will pay 90 percent of the costs of covering these individuals.

Because the money can be accepted at any time, those governors who refused it for this year will likely be facing increased political pressure in the next few years, both as they see how it works in neighboring states, and as local hospitals and providers continue to be unnecessarily strained in providing care to low-income people. They should be pressured. They should also be voted out for so callously dismissing the health of millions of Americans, and the threat of that should certainly be used against them. Maybe that will force more of them to see the light that apparently dawned on Kasich, and maybe more of them will want to save their own political skins.

Originally posted to Joan McCarter on Thu Oct 31, 2013 at 12:18 PM PDT.

Also republished by Daily Kos.

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