Complicated politics of Medicaid expansion are playing out state by state

In Pennsylvania, Gov. Tom Wolf, a newly elected Democrat, is scrapping his Republican predecessor's conservative approach to expanding Medicaid under the Affordable Care Act. Mr. Wolf said this week that he would instead pursue a straightforward expansion of the government health insurance program for the poor, no longer charging premiums or limiting benefits for some enrollees. In Tennessee and Wyoming, however, bills to extend Medicaid to far more low-income residents under the law were quashed by Republican legislators last week, despite having the support of the states' Republican governors. Opponents in both states said that, among other things, they did not believe the federal government would keep its promise of paying at least 90 percent of the cost of expanding the program.