The Supreme Court ruled that states could not lose funding for failing to expand Medicaid, but some Republican governors who refuse to accept the expansion funds could cause friction at the state level. “I will say that as the leader of a state you should care about both the state level costs and municipal costs, but it’s not entirely clear that every governor will. And I think that will be friction,” said Neera Tanden, president of the Center for American Progress. According to a ThinkProgress survey, 10 GOP governors have said they will not accept the funds, while 19 are still deciding. Tanden says “states save a lot of money through their Medicaid” but the problem, or challenge, for some states is that this often occurs at the local level.

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