News that former George W. Bush White House advisor Karl Rove urged his fellow Republicans to abandon attempts to repeal the Affordable Care Act and focus on a replacement plan comes as thousands of Americans sign up for the law’s expanded Medicaid benefits for the poor thanks to changing hearts of GOP governors.

Rove told Fox News last week that any effort to repeal the health law would be met with President Obama’s veto and wouldn’t work politically. So Rove said the GOP Congress instead should come up with alternatives should the U.S. Supreme Court rule against the White House in the King v. Burwell case. The high court will decide next month whether 8 million Americans will lose subsidies for private coverage essentially because they bought private coverage on a federal marketplace rather than state-run exchanges.

But neither King v. Burwell nor Rove’s plea, also outlined in the Wall Street Journal, takes into consideration increasing GOP support for expanded Medicaid coverage gaining popularity among millions of Americans. Although Medicaid expansion ideas vary, more Republican leaders in states are embracing the idea than two years ago and the popularity can be seen in health plan enrollment reports for the first quarter.

A snapshot of Medicaid growth from Republican-led states could be heard in last week’s first-quarter earnings call from Dr. Mario Molina, chairman of Molina Healthcare (MOH), which is seeing unprecedented growth in its health plans from people signing up for coverage under the health law.

“Our health plans in California and Washington have each added more than 100,000 new expansion members since the beginning of 2014,” Molina said told analysts on his company’s first quarter earnings call last week. “And Michigan, New Mexico and Ohio have each added more than 50,000 expansion members as well.”

States like Michigan, New Mexico, and Ohio are all led by Republican governors. Just last month, the Republican-led legislature in Montana approved a proposal to expand Medicaid.

Republican state lawmakers and governors see a deal that puts federal dollars rather than state dollars toward Medicaid. In the past, funding was a 50-50 proposition between states and the federal government but the expansion uses all federal dollars through 2016 and more than 90% federal dollars after that.

Insurance companies like Molina, UnitedHealth Group (UNH), Aetna (AET), Humana (HUM) Anthem (ANTM) and Blue Cross and Blue Shield plans are benefitting financially from steady growth stemming from millions of Americans accessing Medicaid benefits for the first time.

Once the Obama administration signs off on the Montana Medicaid expansion, it will join 28 states plus the District of Columbia that have expanded Medicaid. This year, Indiana’s Medicaid expansion began Feb. 1 under a Republican governor and legislature and Pennsylvania’s began Jan. 1 following approval from a Republican governor before he left office last year. Last year, Iowa, which also has a Republican governor, expanded Medicaid.

Molina and other health plans are optimistic more states will come around to expanding the program.

“Texas and Florida, two states with large numbers of people without health insurance continue to refrain from expanding their Medicaid program,” Molina told analysts. “While lawmakers continue their debate over Medicaid expansion, managed care remains an important value and cost savings proposition.”

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Source: Forbes