Indiana wins approval to expand Medicaid

PPACA required that Medicaid be offered to anyone making less than 138 percent of the federal poverty level, about $16,000 for an individual. The U.S. Supreme Court's 2012 decision declaring the law constitutional made it optional for states to expand the program, which carries the promise of federal funding covering 100 percent of enrollees for the first three years and at least 90 percent after.

Medicaid albatross

Opponents have said taking Medicaid expansion money ties a state to increased spending for the joint state-federal program, and question whether the U.S. government can afford the costs. The issue could be raised during Republican presidential primaries.

Ohio Gov. John Kasich, a two-term Republican and potential presidential candidate, expanded Medicaid over the objections of lawmakers in his own party. He faced questions during a tour of western states last week about whether expanding the program is inconsistent with his advocacy of limited government.

Kasich has talked about the need to help people with mental illness and others who "live in the shadows," and Pence billed the expansion as ending "traditional Medicaid" for adults who aren't disabled.

Pence won concessions from the administration, including the authority to charge premiums to very low-income people. At the same time, the administration secured an expansion of insurance in a Republican-dominated state, and federal officials said the concessions aren't far-reaching.

Hoosiers earning less than poverty-level can't have their insurance cut off for not paying premiums. Pence also failed to win approval to require Medicaid beneficiaries to work or show they are seeking jobs.

Pence, a former six-term congressman elected in 2012, has said he won't announce a decision about running for president until the state's legislative session ends in April.

—With assistance from Alex Wayne in Washington.