The Montana House on Thursday voted to approve Medicaid expansion in the state, making it the latest Republican-controlled Legislature to move forward with the expansion under ObamaCare.
Like other Republican-heavy states, Montana puts a conservative twist on the health insurance program for the poor, requiring beneficiaries to pay premiums and providing for workforce development.
Most recently, Indiana accepted the Medicaid expansion earlier this year after negotiating with the Obama administration over elements like premiums.
In other states, like Utah, expansion has died. Last month, lawmakers there could not reconcile competing bills.
In all, 28 states have expanded Medicaid under the Affordable Care Act, with some Republican states also not considering compromise proposals at all.
There are concerns about the cost of the program and opposition to the healthcare law as a whole. The federal government initially pays the entire cost of Medicaid expansion, but that is then dialed back to 90 percent of costs.
Florida is one of the highest-stakes states, as 800,000 people there could gain coverage under Medicaid expansion.
Gov. Rick Scott (R) this week reversed his position and pulled support for the measure over a distrust of the federal government. He pointed to a showdown with the Obama administration over proposed cuts to a separate pool of federal money for hospitals that serve low-income patients.
In an interview with ABC this week, President Obama urged states to expand the program.
“There are millions of more people that could be helped, and it won't cost the state anything," Obama said. "We're just seeing some stubbornness that's really based on ideology not on wise public health policy that is preventing most people in most states from getting the Medicaid that would save the state money in the long term.”