How Republican Medicaid flip-flops made Obamacare repeal so much harder

Congressional Republicans have been unable to repeal Obamacare because the party has become split on its Medicaid expansion, creating a potentially unbridgeable gap on what a final healthcare bill should look like.

When former President Barack Obama's signature healthcare reform law was enacted in 2010, Republicans on Capitol Hill were unanimous. They opposed expanding the reach of the government's marquee healthcare program for the poor.

In the ensuing seven years, positions have shifted. Senate Republicans are now struggling to pass legislation that would only partially repeal the Affordable Care Act, because of internal divisions pitting Medicaid reformers against preservers of the expansion.

"That's a fair observation," Sen. Mike Lee of Utah, among other Republican lawmakers, told the Washington Examiner on Tuesday. Lee, a conservative with Tea Party roots, continues to favor wholesale repeal of Obamacare.

Medicaid is jointly funded by Washington and the states. Each state runs its version of the program differently but under federal guidelines. Under the Obamacare-facilitated expansion, Medicaid is available to Americans earning 138 percent of the federal poverty level. For a family of four, that's $28,290 annually.