The White House's top health official made clear on Monday that it would not fund a partial Medicaid expansion for states that choose not to embrace the new funding under the Affordable Care Act.
Health and Human Services Secretary Kathleen Sebelius wrote a letter to governors saying the administration "continue[s] to encourage all states to fully expand their Medicaid programs."
In an accompanying blog post, she declared that "the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty."
In other words, the states must take all or nothing. That sets up a dilemma for Republican governors, who have to decide whether to stonewall Obamacare or accept the generous funding to cover their low-income uninsured residents.