Obamacare supporters are seeing a hopeful sign that one of the law's biggest foes, Texas, is rethinking its opposition to the Medicaid expansion.
If Abbott did back Medicaid expansion funding, worth about an estimated $100 billion to the state over 10 years, it would be arguably the biggest "get" for the Obama administration since the Supreme Court made the expansion voluntary more than two years ago.
As Texas attorney general, Abbott joined the lawsuit against Obamacare that reached the Supreme Court in 2012. His predecessor, Gov. Rick Perry, has been one of the most outspoken opponents of the Medicaid expansion, and Abbott campaigned against the Medicaid expansion leading up to the November election.
According to the Texas Tribune report, he's interested in the expansion deal Utah Gov. Gary Herbert struck with the Obama administration after months of negotiations. Herbert's plan would use Medicaid expansion dollars to buy private coverage for low-income adults earning below 138 percent the federal poverty level, or about $16,100 for an individual, with some cost-sharing requirements.
Of the 23 states that haven't expanded Medicaid, Texas by far has the most low-income adults living in the "coverage gap" – people who earn too much to currently qualify for Medicaid but don't earn enough to receive subsidies to purchase health insurance through Affordable Care Act exchanges. About 948,000 adult Texans fall into this category, or about 25 percent of all Americans in the coverage gap, according to the Kaiser Family Foundation.
It's still not clear whether Abbott's thinking on Medicaid has changed. He's recently called for a block grant of current Medicaid funding, which would be a lump sum to run the health-care program with far less oversight from the federal government -- an idea that doesn't sit well with Democrats. And Abbott has said Texas couldn't afford the expansion when the federal funding match drops to 90 percent of the program's cost in a few years.
The expansion issue is far from dead in Texas. A legislative health committee earlier this month rejected the traditional expansion but left the door option for future waiver negotiations with the federal government. A separate federal Medicaid waiver, worth close to $30 billion, could provide a major leverage point for the Obama administration when the waiver expires in 2016.
If Abbott does find a way to accept Medicaid expansion funding, he'd join Republican governors from Tennessee, Utah and Wyoming in supporting expanded coverage since their party cleaned up in the 2014 midterm elections.
Yet, Republican state lawmakers have been far more reluctant to accept this major piece of Obamacare. And 2015 will be a key test for whether lawmakers in one state, Arkansas, will actually roll back the Medicaid expansion.
That's all to say that statehouses across the country remain the big wild card in the ongoing battle over Medicaid expansion.