The Florida legislature rejected Medicaid expansion, despite support from Florida Gov. Rick Scott. Sara Kliff, writing at the Washington Post’s Wonk Blog, notes that Scott’s not the only Republican governor trying to persuade his Legislature to accept the money that comes with the deal.

In Ohio, Gov. John Kasich (R) is having trouble moving the Medicaid expansion he supported through the state’s Republican controlled-legislature. Similar fights are playing out in Arizona and Michigan, where Republican governors find themselves in the relatively odd position of trying to sell Obamacare to state legislators of their own party.

… the Medicaid expansion is a really big deal for state budgets—the budget that Scott is charged with overseeing. If his state had participated in the Medicaid expansion, the Urban Institute estimated it would bring $66 billion of federal funds into the state over the course of a decade.

The problem for many is that the feds can be an unreliable partner. AP recently reported that states were blindsided by an HHS proposal that would shift health care costs for thousands of “uninsurables” covered by a federal program that serves people with serious pre-existing medical conditions.

In a letter this week to Health and Human Services Secretary Kathleen Sebelius, state officials said they were “blindsided” and “very disappointed” by a federal proposal they contend would shift the risk for cost overruns to states in the waning days of the program. About 100,000 people are currently covered.

“We are concerned about what will become of our high risk members’ access to this decent and affordable coverage,” wrote Michael Keough, chairman of the National Association of State Comprehensive Health Insurance Plans. States and local nonprofits administer the program in 27 states, and the federal government runs the remaining plans.

“We fear…catastrophic disruption of coverage for these vulnerable individuals,” added Keough…

The story concludes,

States are free to accept or reject the Medicaid expansion, and the new problems with the stopgap insurance plan could well have a bearing on their decisions.

Progressives have long enjoyed wielding the straw man. “If you oppose expanding Medicaid,” they say, “you oppose health care for the poor. Plain and simple.” But the truth is, if you support expanding Medicaid, you’re doubling down on a failed system, one that shuts the door on real reforms that could provide quality health care to those who most need it.

As of May 1, 16 states plus the District of Columbia have approved the expansion or are headed in that direction, 27 have rejected it or about to and seven states could still go either way.

Called “premium assistance,” the alternative plan would allow states to use federal Medicaid money to buy private insurance for low-income people from new state or federal health insurance exchanges created under the Affordable Care Act. HHS said it would “consider approving a limited number of premium assistance demonstrations” as a way to test how well they work in the real world.