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This paper argues that five governors had a greater chance of winning re-election if they opposed Medicaid expansion instead of supporting it before their Republican primary elections. The five governors were Robert Bentley of Alabama, Nathan Deal of Georgia, Phil Bryant of Mississippi, Nikki Haley of South Carolina, and Bill Haslam of Tennessee. First, a summary of arguments for and against Medicaid expansion in the five states is provided. The next part of the paper seeks to develop a political justification for the decision to oppose Medicaid expansion before the Republican primary elections. This paper concludes that, in the five states, opposing Medicaid expansion is a better political decision because the Republican primary electorate rewards conservative candidates, Medicaid expansion’s connection to President Obama makes it difficult for a Republican governor to support, and a strong argument for Medicaid expansion—its cost-effectiveness—is difficult to explain to voters.

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