In Virginia, leaders in the General Assembly are at odds with each other about expanding Medicaid to 400,000 people in the commonwealth.
The Senate's version of the state's budget would provide publicly funded private health insurance coverage to Virginians who earn too much to qualify for the state's current Medicaid program but not enough to qualify for tax credits on health insurance under the new federal health care law. The House budget would not expand Medicaid eligibility, though lawmakers did include an additional $118 million for the state's hospitals.
University of Virginia Center for Politics analyst Kyle Kondik says he isn't seeing much movement in the House.
"It just doesn't seem that the House wants to go along with it, and of course they can do whatever they want because they have an overwhelming majority in the House," he says.
If the commonwealth does not move forward with expanding the program, millions of tax dollars from Virginia will go to expanding Medicaid in other states. Some Republican-controlled states have moved forward with Medicaid expansion, largely because the program is set up to spend the money anyway.
University of Mary Washington professor Stephen Farnsworth says Republicans in Virginia are in a tight spot.
"Republicans who vote for anything that can be argued is an expansion or an endorsement of Obamacare are likely to be primaried by Republicans who are upset about that," he says.
The next few weeks will be critical, as leaders in the House and Senate craft the final changes to the budget originally proposed by former Republican Governor Bob McDonnell.