Every state in the US has had to deal with the decision as to whether or not to participate in the Medicaid expansion as a part of the implementation of the Affordable Care Act (ACA). The Medicaid expansion was an integral and automatic part of the ACA until the Supreme Court ruled that the expansion is a state option. The purpose, under the ACA, was to assure nearly universal health coverage in the US.
Many analysts see those states that have initially said they will not participate in the expansion as responding to political pressures to halt the successful implementation of the ACA. The opposition is to universal health care coverage as passed under a Democratic majority in Congress.
Those opposing the expansion of Medicaid say that the focus should be on prevention of illness and disease. Few will dispute the need for prevention and encouraging people to lose weight, control their diet, and have a regular exercise program. The problem now, however, is to care for those with chronic diseases, including chronic obstructive pulmonary disease and congestive heart failure, and those who will not have access to any preventive programs in the near future.
Once the political posturing has been done, it is expected that nearly all states will join the Medicaid expansion.