That is, in states where Republicans hold power. Sure, it's a key part in extending healthcare to people with little or no money. Sure, the expansion is fully funded by the Federal Government not the states. Sure, the states can't lose the money they get now if they don't expand their medicaid programs, thanks to the Supreme Court decision. Sure, they'd be crazy to leave so many of their own people behind when other states will be taking advantage of it.
So what? We already know they're crazy and they don't give a damn about their own people. More past the Orange Omnilepticon.
It's clear that the Romney and the Republicans are going to make the campaign all about Obama shoving a giant tax onto the middle class via Obamacare. They're already calling it the largest tax increase in history. Given the absolutely abysmal way Democrats are content to sit back and let the Affordable Care Act sell itself over the next two years as it comes into full effect, they may even get away with it - especially if the White House doesn't come up with a compelling counter narrative.
With that framing in place, every Republican governor has an incentive to drag the issue out for the next for months at the latest, in hopes a Romney White House and Rovian Congress in January 2013 will immediately repeal everything - or at least gut it to uselessness. They will do nothing to set up the insurance exchanges called for by the act, leaving that up to the Federal government. Then they'll use that to buttress their narrative about Washington taking over healthcare. They'll fight health care reform in every way they can. And expanding Medicaid?
Free money from Washington to pay for expanding Medicaid to the poor? They won't touch it. They'll use the same arguments they used to turn down money for infrastructure improvements, like an additional tunnel under the Hudson River from New Jersey, rail improvements in Florida, etc. etc. They'll claim it's a trap, that they'll just be setting up the states to get stuck with the bills when the Feds someday cut the funding but insist on the mandate. They'll warn the money will be wasted on freeloaders and fraud. They'll speak darkly of the loss of freedom as people become addicted to the government for everything. They'll speak of hordes of disease-ridden illegals coming to the U.S. for free medical care. They'll condemn the entitlement culture (so long as it doesn't include the rich.) They'll talk about moral hazard and people who should suffer because they don't live healthy lifestyles. They'll rant about Broccoli-Apocalypse now! They'll do everything they can to sabotage the whole program - and then say that 'proves' it doesn't work. They'll scream TAX! TAX! TAX! from sun up to sun down and all the hours between.
In short they'll lie and just make shit up. Just like they've been doing all along.
For the hardcore conservative tea party GOP rogues, reprobates, and reprehensibles, expanding Medicaid is the last thing they want to do. Poor people are not their base. Making government provide any service for anyone is not in their interest as the party of small-government-you're-on-your-own-teabaggian-randian incoherence. The voters that put them in power don't give a damn about other people dying for lack of healthcare. (That changes real fast when they get sick of course.) They'll eat this rhetoric up.
Even the argument that the tax dollars they refuse to take from the Federal government for their state means their tax money will go to Washington to help other states doesn't matter. The dirty secret of the GOP is that many of the states that are their base get more money from Washington than they ever give back. The worst thing that could ever happen would be if the Federal Government really did 'get off their backs' and stopped propping them up.
Bottom line: even 'free money' from Washington will not be enough to make some of these states go ahead with Medicaid expansion. They'll fight it every step of the way. These are the same people who left New Orleans to drown, the same people who want to 'save' Social Security by raising the retirement age and cutting benefits, the same people who want to turn public schooling into a race to the bottom with vouchers, the same people who are terrified of people of the wrong color, the same people who blundered us into two wars they couldn't finish.
Why should we expect them to behave any differently now?
4:34 PM PT: UPDATE: Checking the Rec List, John Perr aka Avenging Angel has a diary about this topic with charts and numbers. Take a look at: "GOP governors fight to preserve dismal red state health care" It's happening - the question is how long they'll keep it up.