Republican victories in top governors' races have dashed Democratic hopes of expanding Medicaid in more states under ObamaCare.
Voters reelected GOP governors in Kansas, Maine, Wisconsin and Florida on Tuesday night — all races that could have boosted hopes for expansion had Democrats won.
The election results might also threaten the alternative Medicaid expansion implemented in Arkansas under Gov. Mike Beebe (D), who was term-limited out of office.
His replacement, Republican Asa Hutchinson, does not appear interested in protecting the program, which must be reauthorized by the legislature every year.
The Obama administration appeared to be counting on wins in governors' races Tuesday night to push the expansion forward.
Health and Human Services Secretary Sylvia Burwell delivered a speech to the National Association of Medicaid Directors (NAMD) on Tuesday in which she urged new governors to call her if they want to talk about their options.
"We're eager and willing to work with states that have yet to expand," Burwell told the NAMD conference near Washington, D.C.
"My message to governors is that, 'If you're interested in expanding, call me.' And to those governors who are about to get elected or reelected today, my message is that 'I'm happy to meet with you before your inauguration.' "
Twenty-seven states and the District of Columbia have accepted the expansion, which was made optional by the Supreme Court in 2012.