At annual meeting, U.S. governors come out swinging over Medicaid

WILLIAMSBURG, Virginia Sat Jul 14, 2012 1:52pm EDT

Policemen talk in front of the U.S. Supreme Court in Washington June 18, 2012. REUTERS/Kevin Lamarque

Policemen talk in front of the U.S. Supreme Court in Washington June 18, 2012.

Credit: Reuters/Kevin Lamarque

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WILLIAMSBURG, Virginia (Reuters) - The Supreme Court decision allowing U.S. states to opt out of expanding Medicaid, the health insurance program for the poor, is pitting governor against governor, with Democrats accusing Republicans of being more concerned with election-year politics than solving healthcare problems.

The issue that dominated the annual National Governors Association meeting this weekend in the historic Virginia town of Williamsburg was the court's ruling that Congress cannot penalize states who refuse to enroll a wider group of people in Medicaid, which is operated by states with federal reimbursements.

The Affordable Care Act, which would expand coverage to families with incomes of up to about $30,000, had directed Congress to withhold Medicaid funds from a state that did not expand the expensive program, which already can take up to a third of state spending.

In the two weeks since the court's decision, five Republican governors have opted out of expanding their states' programs and at least four more are leaning toward the same. Many more are undecided. These governors say they were caught by surprise after expecting the court to either strike down or uphold the entire law that they derisively call "Obamacare."

"We're going to make a very careful review of it and do what I think is best for the people of Pennsylvania," Governor Tom Corbett, a Republican who came into office during the party's strong showing in the 2010 elections, told Reuters on the sidelines of the conference. "The Supreme Court decision changed the dynamic."

He bristled at the notion, offered by Democrats, that he was only half-heartedly considering the option to appease political supporters, saying he would not "comment on other governors criticizing the governors who are taking their time to review this."

Democrats say the extra federal money attached to the expansion will prove too good for most governors to pass up, especially as Medicaid and other healthcare costs continue to soar. Under the healthcare law, states will be reimbursed 100 percent for anyone who enrolls during the expansion. That rate will eventually taper off, but only to 90 percent.

Vermont Governor Peter Shumlin, a Democrat, said Republicans will criticize the Medicaid directive but then accept the additional money.

"My guess is that they will beat up the president for passing a great bill until he's re-elected and then join up and take the money because they know it's the best thing for their states," he told Reuters.


Some states already grant benefits to more people than the federal Medicaid program covers and consider the Affordable Care Act a reprieve from costs they have shouldered alone.

"The Republicans don't really mean what they're saying. If in fact this law is enacted as of 2014, I urge every Republican governor who says they won't take the money after the election to resign if they end up taking the money," Connecticut Governor Dannel Malloy, a Democrat, said. "It's far beyond posturing. They're trying to impact a presidential election by telling untruths."

For Republicans, though, the presidential election affects their decisions on the expansion. Governor Mary Fallin of Oklahoma told reporters she would decide on the option before the election, but noted the presumptive Republican presidential nominee, Mitt Romney, has said he would repeal the law.

Her fellow Republican, Virginia Governor Bob McDonnell, a rising star in the party, would not commit to a timeframe for expanding Medicaid or for deciding on creating a state-run exchange for private insurance. His state was the first of 26 to sue the federal government over the law.

"The presidential race does impact the healthcare decision, because I don't want to spend any taxpayer money - either federal taxpayers or state taxpayers' - in building an exchange or expanding a program that may look dramatically different in six months," McDonnell said at a news conferences.

Delaware Governor Jack Markell, set to head the governors' group, embraces the expansion as the most prudent spending choice. If more people have insurance, fewer uninsured people will turn to expensive emergency rooms to treat minor issues and pass the bill onto taxpayers, the Democrat said.

"We have to understand there is a really significant cost of doing nothing and it's the cost of uncompensated care," he said in an interview.

While the governors meeting is intended as a bipartisan exchange of ideas, Markell said that the weekend's interactions would have little influence on his decision.

"Governor McDonnell and I have fundamentally different approaches to the expansion, and my guess is at the end of the day, he and I are... going to stay where we are," he told a news conference.

(Editing by Philip Barbara)

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Comments (18)
UnPartisan wrote:
“The Affordable Care Act, which would expand coverage to families with incomes of up to about $30,000, had directed Congress to withhold Medicaid funds from a state that did not expand the expensive program, which already can take up to a third of state spending.”

This was a major provision that lowered the Federal Costs of the Affordable Care Act, by shifting it to the States. No fiscally minded governor will accept this now that it has been struck down by the Supreme Court and they effectively have an out. I guess states that have money and can afford to expand it may wish to do so. But any state that is struggling like California will have to weigh the costs agains their existing budget.

Jul 14, 2012 3:19pm EDT  --  Report as abuse
idlespire1 wrote:
@Unpartisan: Did you actually READ the article? 100% is covered by the Federal Govt at first with it lowering to 90% eventually. The Federal Govt is actually shouldering the vast majority of the expansion. Though I guess facts don’t actually matter to most conservatives. All they want are talking points to stir up their base.

Jul 14, 2012 3:50pm EDT  --  Report as abuse
nirmasuma wrote:
Chief Justice John Roberts joined the Democrat justices and upheld ACA and then joined the Republicans and ruled that States cannot be compelled to expand Medicaid by coercion. The whole thing was so totally unexpected nobody knew at that time conclusively with whom he had sided. Both parties claimed victory. Democrats thought no State can afford to give up ACA and the huge federal handout accompanying it. Republicans thought they can effectively make ACA a paper tiger, by refusing its implementation in States. But slowly now it is dawning on Republicans that CJ Roberts had dealt them a double whammy.

If Republican governors refuse to accept ACA, most likely those States will not be voting for GOP Senators if they are due for election this year. Everybody knows self-interest takes precedence over national interest, always. When ACA had not been implemented before 2010 or when it was before the Supreme Court, it was a different matter. Economy was really in the pits and debt was a word most hated by everybody. GOP played on this and got majority in the House in 2010. But now it is a different scenario. People are slowly realizing its benefits after its partial implementation. Supreme Court’s seal of approval has nullified the most important objection of GOP to that Act. Now people want it. While there might be a lingering hope of GOP either winning the Presidential election or getting a majority in either or both legislatures and hold up the Act from being implemented effectively, not many subscribe to that.

In the circumstances, GOP governors have been left with a Hobson’s choice. They can either accept ACA now or do so after the election. If they do now, they will lose face. But after losing the House and Presidency, if they accept it after the election (or continue to refuse its implementation their states) in the election in 2014, GOP will lose totally both legislatures, probably forever. They have been able to use their obstructionist tactics to hold up the economy. But it has been used enough and with Democratic super majority, GOP will not be able to do so after the election. The economy is also improving. If at all they still attempt it, in 2014 GOP will be decimated.

CJ John Roberts is no fool. He knew which side of the bread was buttered. Once one more democratic justice is nominated by the President, Roberts will always side with the democrats (he will not have any choice!) and be written about in history as the CJ who helped a Democratic President to completely transform the USA as a nation which really cares for its poor and real democracy.

Jul 14, 2012 4:17pm EDT  --  Report as abuse
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