"President Joe Biden’s administration has offered a $1.5 billion bonus to incentivize states that haven’t expanded their programs. That played a role in North Carolina's change of heart, as GOP legislators say they’ve found a way to expand the state's Medicaid program without raising taxes or compromising quality of care. Expect the last 10 states, most of which are strongly Republican, to eventually sign on, too."
"Several factors have made it more palatable for Republican states to adopt the expansion. First, the ACA is helpful to hospitals in less affluent rural communities, which often are Republican-leaning areas. And hospitals are the big institutional losers under the ACA when a large number of their patients remain uninsured.
Expanded Medicaid remains a great deal for state budgets, since the federal government covers almost all the costs. Right now most states have healthy budget situations, but when they don't? It's going to be hard for them to say no to an easy fix."
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