Now, it appears, more diverse voices are questioning state Medicaid expansion under the Affordable Care Act (ACA).  Last week, the Utah Hospital Association (UHA) urged the state not to expand Medicaid.  And, this week, the American Medical Association’s (AMA) governing body voted against lobbying for the expansion. Previously, the discussion regarding whether or not states would fall in line and expand their Medicaid programs focused on gubernatorial politics.

In National Federation of Independent Business v. Sebelius, the Supreme Court ruled that the states could decide whether or not to implement the Medicaid expansions under the ACA without penalty.  Republican governors in Florida, Georgia, Louisiana, Mississippi, South Carolina and Texas have pledged that their states will not join.  Many states, like Utah, were waiting on the outcome of the presidential election to decide.  The UHA’s position against the expansion was unanticipated, and may impact Utah’s participation. On Nov. 13, 2012, the ACA took another blow when the AMA’s governing body decided not to advocate for Medicaid expansion. The AMA’s vote represented the loss of a potential ally in the fight to win state participation. 

The decisions by the UHA and the AMA not to support Medicaid expansion sends a strong message that state participation may be more difficult to obtain than previously thought. If state Medicaid expansion continues to lose potential allies like the AMA and gain vocal critics like the UHA, a key component of the ACA could be crippled.