• Time to imagine your best "Godfather" voice: Hey, State. The federal government is gonna make you an offer you can't refuse.
• If states expand their Medicaid programs to cover all people at 133 percent of the federal poverty level and below, the feds will make it a pretty sweet deal: The federal government will cover 100 percent of the cost of the expansion for three years (2014-16), and at least 90 percent thereafter.
• "I can tell you as a return on investment, as a governor, I would have given my eyeteeth to have that kind of deal with the federal government," said Kathleen Sebelius, current Secretary of the Department of Human Services and former governor of Kansas, as she addressed the National Rural Assembly in Bethesda, Md., on June 25. "It's a way to really expand healthcare for millions of people, and a large share of that paid for."
• When Congress passed the Patient Protection and Affordable Care Act in 2010, the Medicaid expansion was meant to be something that states actually couldn't refuse: The expansion was mandatory. A Supreme Court decision in 2012, while letting the rest of the PPACA stand, made the Medicaid expansion optional for states.
• Thus far, 24 states have nevertheless agreed to expand their Medicaid programs. North Dakota is one of them.
• Gov. Jack Dalrymple did not approve of the overall health care law, but said he tried to leave politics out of the discussion when considering expansion of Medicaid.
• "In the end, it comes down to are you going to allow your people to have additional Medicaid money that comes at no cost to us, or aren't you?" he told the Grand Forks Herald in January. "We're thinking, yes, we should."
• Republican state legislators in North Dakota said they reluctantly voted for the bill because of the cost to the state if they did not do so, according to an Associated Press story. The law passed in April.
• South Dakota is on several national lists as a state with governor who has refused to expand Medicaid, despite the fact that Gov. Dennis Daugaard appointed a task force that met over the summer to look into the pros and cons of expansion. The task force finished its study on Aug. 20 and summarized its findings in a 40-page report, which will be released after a few changes are made, according to an Associated Press story.
• On the "pro" side, the task force found that Medicaid expansion would expand health care coverage to thousands and might improve the state economy. On the "con" side, it found that Medicaid expansion would cost the state millions.

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