While Republicans in Congress openly criticize the Affordable Care Act, many of the party’s governors welcome the flow of federal funding it offers states to include more people in Medicaid, the nation’s health insurance program for low-income residents. Many of those state leaders also dislike the Affordable Care Act but see the influx of cash as an opportunity to provide better health coverage to poor individuals and families.

At least 10 states with Republican governors have recently expanded Medicaid, the New York Times reports, including Indiana, Arkansas, Iowa, Michigan, New Jersey, Arizona, Ohio and Nevada. In Ohio, Gov. John Kasich expanded coverage to include more than 600,000 residents who would have otherwise had to purchase private insurance or go without and pay a tax penalty.


The Affordable Care Act offers states federal money to provide Medicaid coverage to more people. If states have residents who are at or below 138 percent of the federal poverty level -- meaning they earn no more than $16,242 -- the federal government will pay 100 percent of the costs to cover those new beneficiaries through 2016. Afterward, the government will continue to pay at least 90 percent of the costs. Opponents of expansion point out that this plan still sticks states with 10 percent of the bill.

Republicans in Congress have fought to reform or repeal the healthcare act since it was signed into law by President Barack Obama in 2010. Though Democrats originally wanted to require states to broaden Medicaid coverage, the Supreme Court ruled in 2012 that expansion must be optional. So far, 30 states have chosen to do so.  

Joan Alker, a health policy expert at Georgetown University, told the Times the split in opinion is a disagreement among “idealogical” Republican leaders, who despise the Affordable Care Act and seek to repeal it, and “pragmatic” ones, who recognize a need for affordable health coverage. The divide is also largely drawn between Congressional Republicans responsible for the federal budget and state GOP leaders receiving the funds.