Reuters is reporting that Republican-controlled states who made "bold" proclamations about never accepting the expanded Medicaid option for the poor uninsured under the Affordable Care Act, derisively known as "Obamacare," are beginning to come around by following the lead of Pennsylvania.
President Barack Obama's plan to extend health coverage to millions of poor Americans remains highly contentious, yet it is gaining momentum among several initially reluctant states where financial pragmatism is trumping ideology.
Up to a dozen states, including several led by Republicans, could move forward with plans to expand coverage under Medicaid after the November elections. They take their cue from Pennsylvania and other states that have won Washington's approval to add commercial innovations to the 50-year-old government program to make it more palatable to conservatives.
Obama's original idea of using tax money to expand Medicaid has long been a hot button for Republicans who portray the whole Obamacare healthcare overhaul as a form of socialism encroaching on American values of free enterprise and self-reliance. Texas Governor Rick Perry once said expanding Medicaid would be similar to "adding a thousand people to the Titanic."
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But two things have led to a change of heart for some Republican politicians.
Most of the 27 states that are already expanding the program have begun to reap billions in federal subsidies for insurers, hospitals and healthcare providers, putting politicians elsewhere under intense pressure to follow suit.
As demonstrated by Pennsylvania's deal with Washington, the Obama administration has also proved willing to accept tweaks that give the private sector a greater role in providing healthcare and place new responsibilities on beneficiaries.
All of that has got as many as nine states talking to the administration about potential expansion terms, with the possibility of up to three more joining the fray depending on November's election outcomes. As a result, there could be even more pressure on Republican states that have opted out, providing critical mass for an initiative central to Obamacare.