High Court's Medicaid decision could have long-term repercussions

Leaders in some Republican states have already indicated that they will abandon the health law's Medicaid expansion after last week's Supreme Court decision on this part of the health law.  

The Washington Post: Health Care Ruling Raises Thorny Questions About Practical, Financial Ramifications
The Supreme Court's announcement Thursday that states can opt out of the 2010 health care law's expansion of Medicaid without losing current federal funding has raised some thorny questions about the practical and financial ramifications. Take the debate raging over what would happen to federal spending if some states decide against participating in the expansion, which will be almost fully funded by Washington. The federal government would save money because poor people who would otherwise have been newly eligible for coverage would no longer get it (Aizenman, 6/29).

Bloomberg: Limits On Spending Power Seen As Health Ruling's Legacy
The Supreme Court decision upholding President Barack Obama's health care law has drawn attention for limiting Congress's authority over interstate commerce, yet constitutional scholars say its biggest impact may be a curb on lawmakers' ability to alter state Medicaid funding (Drummond, 7/1).

Politico: Lew: 'Vast Majority' Of States Will Expand Medicaid
White House Chief of Staff Jack Lew played down the Supreme Court's ruling to make the Medicaid expansion voluntary on Sunday, saying he expects "vast majority of states" will participate. "To be clear, the expansion of Medicaid coverage for those who can't afford it was upheld," Lew said this morning on ABC's This Week. "And states are now in a position where the federal government is saying we will pay 100 percent of the cost of covering those people." When Medicaid was introduced in the 1960s and the Children's Health Insurance Program was created in the 1990s, the states all eventually came in despite initial qualms and a smaller federal contribution, Lew said (Norman, 7/1).

The Associated Press: Some GOP States Want To Abandon Medicaid Expansion
Republicans in at least four states want to abandon an expansion of Medicaid in President Barack Obama's health care overhaul, and more than a dozen other states are considering it in the wake of the Supreme Court decision removing the threat of federal penalties. The high court upheld most of Obama's law, but the justices said the federal government could not take away states' existing federal Medicaid dollars if they refused to widen eligibility to include adults who are only slightly above the poverty line. Some Republican governors and lawmakers quickly declared that they would not carry out the expansion (Lieb, 6/29).

Reuters: Florida Says No To Two U.S. Health Care Law Features
Florida will not implement two provisions of the U.S. health care law involving an expansion of Medicaid for the poor and creation of a private insurance exchange, Governor Rick Scott said on Sunday. Two other states with Republican governors, Wisconsin and Louisiana, opted out of the two provisions last week in the wake of the Supreme Court decision upholding the Patient Protection and Affordable Care Act (7/1).

The Wall Street Journal: Conn. Seeks To Tighten Medicaid Eligibility
Connecticut officials believe some parents of college-aid children are taking advantage of the state's Medicaid health-insurance program for low-income adults, seeking government subsidies for their children's health care so they don't have to pay for private insurance (Haigh, 7/1).

Richmond Times-Dispatch: Va. Has Tough Medicaid Choice To Make Under Health Care Law
"There wasn't one person that I know who had expected that outcome," said Cynthia B. Jones, director of Virginia's Medicaid program and a board member of the National Association of Medicaid Directors. "There are no answers at this point." While elected officials in some states already have declared opposition to Medicaid expansion, Jones and other Virginia officials, including Gov. Bob McDonnell, are taking a more measured approach to the choice that the ruling allows. "What everyone is talking about is stepping back to make sure you are very careful about that question," said Jones, who spoke with other members of the national association's board on Friday about states' choices (Martz, 6/1).

The Dallas Morning News: County Taxpayers Stand To Lose If Texas Rejects Medicaid Expansion
States that look skeptically at a massive expansion of Medicaid under the Affordable Care Act were among the winners in last week's Supreme Court health care ruling. Among the possible losers: county taxpayers. If the Texas Legislature chooses not to expand its Medicaid rolls in 2014 to cover an additional 1.5 million people, counties and public hospitals would continue to shoulder the burden of paying for the uninsured, who often seek expensive care in emergency rooms. Unlike many states, Texas does not directly subsidize the cost of caring for the uninsured (Michaels, 6/30).

Houston Chronicle: Politics, Ideology Clash Over Expanding Medicaid
If the political rhetoric that accompanied last week's Supreme Court ruling on health care reform was any indication, Texans can expect a raucous few months ahead as politicians consider whether to accept billions of federal dollars to expand Medicaid coverage to as many as 2 million low-income Texans. The stakes are high, both politically and for the people who could gain coverage. Gov. Rick Perry and other Texas leaders have shown little interest in participating, although that may change as the federal government dangles the money as bait (Kever, 6/30).

The Atlanta Journal-Constitution: Georgia Faces Tough Call On Medicaid
The U.S. Supreme Court has upheld the health care overhaul, but Georgia's emergency rooms and free clinics may still be jammed with the uninsured years after that landmark ruling. … How close Georgia comes to universal coverage, however, is largely up to the state itself, and Georgia's elected officials now have a profoundly important decision to make: Will they expand Medicaid by hundreds of thousands of people, jacking up the cost of an already costly program, or will they undermine the health care overhaul by removing one of its pillars? ... Safety net hospitals were already worried about taking care of an estimated 600,000 Georgians who are expected to remain uninsured even if the law is fully implemented. The possibility of the law going forward without the Medicaid expansion raised that concern to a new level last week (Teegardin and Williams, 7/1).

(St. Paul) Pioneer Press: Health Care: Law Stands, So Must Minnesota Get Moving?
The Supreme Court's decision to uphold the federal health law has raised new questions about exactly how -- and whether -- the state will further expand Medicaid health insurance coverage for low-income residents…. On Medicaid, the administration of Gov. Mark Dayton remains committed to a full expansion of the Medicaid program as was envisioned by the 2010 health law. But the court's ruling Thursday made the expansion optional for states -- and leading Republicans think Minnesota would be wise to put the brakes on a further expansion (Snowbeck, 6/30).

California Healthline: Expanding Medicaid Called 'Right Thing To Do'
The CEO of a trade group representing safety net health plans in 26 states hopes other states follow California's example and make plans now to expand Medicaid. "The Supreme Court's ruling on the expansion of Medicaid is unlikely to materially affect the efforts of health plans in California since the state has indicated that it would participate in the expansion," said Margaret Murray, CEO of the Association for Community Affiliated Plans, which represents 59 non-profit safety net health plans in 26 states. … As a jumping-off point to Medi-Cal expansion, California takes advantage of a five-year Medicaid waiver program, "Bridge to Reform," ending in 2015. The waiver program, implemented by county health agencies, is bringing about two million new enrollees into Medi-Cal with $10 billion in federal resources (Edlin, 7/2).