With no success for several years, Gov. Jay Nixon has urged Missouri lawmakers to expand the state's Medicaid program to 138 percent of the federal poverty level.
It's a change that, at least in the short term, brings additional federal dollars to the state to support the combined federal-state program.
But the Legislature's Republican leaders and majority members haven't warmed up to the idea.
On Thursday afternoon, Senate President Pro Tem Tom Dempsey, R-St. Charles, told reporters the idea remains a non-starter.
"We have a lot of members who are concerned about - share the concerns that our constituents have about - the affordability of care, the quality of care and the costs of care," he explained. "What we have always disagreed with is the one-size-fits-all federal solution.
"But we do care about health care reform, and that will be an item for discussion next week" at the Senate Republicans' caucus to fill in the details of their 2015 legislative agenda.
Nixon said Wednesday he still supports the idea.
"Clearly, it's the right thing to do," Nixon said. "Not doing it is causing not only a drag on health care opportunities for folks, but also a drag on the economy.
"We're coming up on January, and it's $2 billion that Missourians have paid in taxes that are not being used here in our state - and states that have been effecting that (expansion) are able to move their states forward.
"One in every six jobs is health care."
Nixon doesn't think it's a partisan issue, but acknowledged that others do.
Senate Appropriations Chairman Kurt Schaefer, R-Columbia, said he and other budget writers have been watching the way Medicaid expansion works in other states.
"The data that we've seen is, there are no better health outcomes in those states that adopted expansion," Schaefer said. "The data I've seen from Washington, Oregon and other states that were out early and now have more data than other states - show that they do not have a difference.
"The issue, too, is there are all these costs."
Congress included Medicaid expansion as part of the controversial Affordable Care Act - commonly called "Obamacare" - but the U.S. Supreme Court ruled Medicaid expansion was a state decision even though the health care mandates in the law were constitutional.
Schaefer said more and more people are reporting problems with rising costs and fewer benefits from the federal law.
"I think what you saw on Tuesday was a response to what people now know, which is it's increased costs, it's worse service and it's fewer options," Schaefer said, "people don't want it."
Nixon promised to keep talking with legislative leaders about the idea.