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States and the White House are negotiating over details of two key elements of Obamacare — expansion of Medicaid and Health Insurance Exchanges.
The expansion of Medicaid benefits under the Affordable Care Act was expected to help about 15 million uninsured people gain health insurance. But the program is in trouble, with only about a dozen states so far saying they will extend their current Medicaid programs. Thirteen states have indicated strong opposition to extending Medicaid benefits, citing the fear the program will end up costing them money because they do not trust federal guarantees of financial support for it.
The Health Care Act also offered states a chance to set up their own Health Insurance Exchanges to offer insurance to the about 15 million uninsured citizens who would not qualify for Medicaid. So far, at least 21 states have told the administration they will not create those exchanges, requiring the federal government to step in and create exchanges for those states.