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Supreme Court ruling on Medicaid tees up campaign issue

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And in states with Democratic governors and Republican-controlled legislatures, like New Hampshire, state lawmakers say they’re already working on a plan to block Medicaid expansion.

“There’s a deep suspicion among people who didn’t like Obamacare to begin with over the costs,” says Susan MacManus, a political scientist at the University of South Florida in Tampa. “And the other side is saying, ‘Well, how can you dare leave this money on the table?’ ”

Since the Supreme Court ruled last Thursday, “the line in the sand has gotten much deeper and clearer,” Ms. MacManus says.

Under the Affordable Care Act (ACA), which goes into full effect on Jan. 1, 2014, eligibility for Medicaid expands to cover those with incomes up to 133 percent of the federal poverty line (or $25,390 for a family of three). As originally envisioned, states that choose to opt out would be penalized by losing their existing federal Medicaid funding. But the court struck down the penalty as coercive.

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