By Letitia Stein
(Reuters) - A legislative push in Montana to extend Obamacare health coverage to the working poor got a last-minute reprieve this week thanks to a procedural play by supporters, and similar efforts in other conservative states are flagging.
Some half dozen holdout states have been considering whether to join 28 states and the District of Columbia in accepting billions of federal dollars to expand Medicaid under the Affordable Care Act, President Barack Obama's program to provide healthcare to most Americans.
A brawl broke out this week in Montana, where a Republican House committee effectively killed the last legislation allowing the state to take the federal money. But supporters of the measure outmaneuvered opponents on procedural rules and resurrected the bill for debate on Thursday.
The showdown in Montana lays bare a bitter ideological divide stalling the expansion of Medicaid coverage in states concentrated in the U.S. South and central West.
At one point, experts had predicted that up to a dozen of them could reverse course this year and open up to Obamacare.
That would require providing coverage to working adults who fall into a so-called coverage gap under Obamacare - too poor to purchase plans under its health insurance exchanges, but unable to qualify for traditional state Medicaid programs.
"Medicaid expansion is a real challenge for Republicans and it has been harder for Republican legislators than governors," said Caroline Pearson, senior vice president of Washington-based healthcare consultants Avalere.
In many states now debating expansion, business groups and moderate Republicans have come around to the economic arguments for accepting the federal money, but cannot persuade GOP hardliners vulnerable to Tea Party sympathizers.
The debate has aroused conservative opposition backed by Americans for Prosperity, a political group supported by billionaire brothers David and Charles Koch.
AMERICANS FOR PROSPERITY
From Florida to Tennessee, the group has taken to airwaves and flooded mailboxes to blast state Republicans for wavering on Obamacare.
Americans for Prosperity has 10 field offices in Florida, the largest presidential swing state, where it has staged a high-profile campaign to stop Obamacare.
With the Republican legislature deadlocked on the issue, Governor Rick Scott backpedaled on Monday on his earlier support, long tepid.
"We hold politicians accountable, regardless of their party, particularly if they use the mantle of 'conservative' or 'limited government principles' and then they do the opposite," said Adam Nicholson, a regional communications manager for Americans for Prosperity.
Tennessee has also felt the influence of the group's field operation, which can deploy more than 500 staffers on Medicaid and other issues in 33 states, up from fewer than 100 in 2010.
The group helped defeat the Medicaid expansion plan championed by Tennessee's Republican Governor, Bill Haslam, by linking it to Obamacare.
"Tennessee is a red state and there is a reaction to anything that is associated with Obamacare," said Charlie Howorth, spokesman for the pro-expansion Coalition for a Healthy Tennessee, which is backed by business groups and hospitals.
Similar fights are in their final rounds in Alaska and Missouri. In Utah, one of few states where the issue remains in play, the legislature adjourned empty handed, but is still holding discussions.
In Montana, after a week of wild politics, all bets are off.
"This will be the last chance," said Dick Brown, president of the Association of Montana Health Care Providers, noting that when legislators in his state go home in a few weeks, they will not return for two years.
"Who knows what happens then," he added.
(Additional reporting by Bill Cotterell in Tallahassee, Fla. Editing by David Adams and Andre Grenon)