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“There is a tremendous gap in the law … When Congress passed the law, it assumed Medicaid for the poorest people,” said Sara Rosenbaum, chairwoman of the Department of Health Policy at George Washington University. “The bottom line on the whole is that if you don’t expand Medicaid, people are going to be without coverage.”

Mr. McKissick, who represents parts of North Carolina’s Durham and Granville counties, echoed those thoughts on Monday’s conference call.

“It was assumed Medicaid would be expanded,” he said, adding that rural hospitals in his district and across the state will continue to shoulder the cost of the uninsured flocking to emergency rooms and sticking taxpayers with the tab.

While the debate over Medicaid expansion has broken down largely along party lines, there are exceptions.

The White House frequently points to Republican governors such as Arizona’s Jan Brewer and Ohio’s John Kasich who have embraced the idea and allowed it to move forward in their states, despite strong opposition to Obamacare as a whole.