Medicaid expansion draws mixed reaction from states

In the wake of the Supreme Court ruling making the law's Medicaid expansion optional, some state officials say they will opt out because they cannot afford even 10 percent of the program's costs. Others, though, are moving forward.

Kaiser Health News: States Balk At Expanding Medicaid
Hours after the Supreme Court upheld President Barack Obama's health law on Thursday, but made its Medicaid expansion optional, senior White House officials were asked by a reporter how they would entice states to participate. They laughed. It seemed almost inconceivable to them that states would opt out (Galewitz, 7/2).

The Wall Street Journal: Some States Balk At Medicaid Expansion
Opposition to expanding Medicaid under the health-care overhaul is hardening in some Republican-led states, as Gov. Rick Scott of Florida said over the weekend that he will opt out. His decision puts the former hospital executive at odds with state hospitals. Another half dozen Republican-led states-;Iowa, Louisiana, Mississippi, South Carolina, Texas and Wisconsin-;say they, too, may opt out of widening eligibility for the federal-state insurance program for the poor starting in 2014 (Radnofsky, Mathews and McWhirter, 7/2).

The New York Times: Republican Governor Of Florida Says State Won't Expand Medicaid
In another sign of resistance to President Obama's health care overhaul, Gov. Rick Scott of Florida, a Republican, said Monday that his state would not expand its Medicaid program (Pear, 7/2).

Market Watch: Orszag Says Health Law's Medicaid Extras Will In Time Win State Support
Several governors of states, notably in Florida, have already come out and said they will take advantage of the Supreme Court's health care decision not to offer additional Medicaid coverage. That's important because the changes to Medicaid are supposed to account for roughly half of the 30 million people who are supposed to get health-care coverage. But Peter Orszag, vice chairman of global banking at Citigroup and President Obama's former director of the Office of Management and Budget, said Monday that he expects states will eventually change their mind (Goldstein, 7/2).

Politico Pro: 4 Ways States Might React To Medicaid Ruling
The states' responses won't be clear for some time. But here are four scenarios to watch. 1) Red states opt out: The right to sit out the Medicaid expansion was one reason the 26 states went to court in the first place. … 2) Red states make noise, but then take the money: The White House is hoping that most, if not all, of the 26 states will see that big heap of federal Medicaid money on the table –– and take it. … 3) States will try to negotiate their terms for the expansion -; particularly by trying to have more control over the program. …4) Red states put some in Medicaid, punt the rest to exchanges (Kenen and Feder, 7/3).

Politico Pro: States Choosing Not To Opt Out Of Expansion
The Supreme Court ruling put a spotlight on red states resisting Medicaid expansion, but some states are quietly moving ahead with plans to cover a lot more of their low-income population. Washington state Medicaid Director Doug Porter has been asked many times since Thursday if his state was rethinking the expansion (Smith, 7/3).

The Hill: Fifteen Governors Reject Or Leaning Against Expanded Medicaid Program
At least 15 governors have indicated they will not participate in the expansion of Medicaid under the healthcare law, striking a blow to President Obama's promise of broader insurance coverage. Before Thursday's Supreme Court ruling, states had the option of either increasing their Medicaid rolls or being penalized by the federal government. The high court struck down that offer as unconstitutional. Governors still have a financial incentive to participate in the expansion of coverage for low-income people, since the government will foot most of the bill through 2016 (Viebeck, 7/3)?

Des Moines Register: Branstad Is Firm On Opposing Idea To Grow Medicaid
Gov. Terry Branstad reaffirmed his resistance to expanding Medicaid on Monday, a stance that could reject $800 million annually in federal money to cover 150,000 poor Iowans without health insurance. The Republican governor has long raised doubts about President Barack Obama's plan to expand Medicaid, which now generally doesn't cover poor adults who lack minor children or serious disabilities (Leys and Clayworth, 7/2).

NewsHour: In Wake Of Health Reform Decision Medicaid Expansion In The Crosshairs
Under the law, Washington would pick up 100 percent of the cost of bringing about 17 million Americans into the Medicaid program. By 2020, that would drop to 90 percent, with the states picking up 10 percent indefinitely. Some states see that as a good deal, and for good reason, said Genevieve Kenney, a senior fellow at the Urban Institute. ... But since the law was signed in 2010, state and local governments across the country have been going broke under the weight of the sour economy and dwindling tax revenues. ... Even at 10 cents on the dollar, some of those states are saying they simply can't afford a Medicaid expansion (Bowser, 7/2).

Medpage Today: After Court Decision, All Eyes On States
While the court found the Medicaid expansion is constitutional, it ruled that the provision in the law that gives the Secretary of Health and Human Services (HHS) the authority to financially penalize states that don't comply with the expansion -- by withholding federal Medicaid matching funds -- is not constitutional. … For some states with very limited Medicaid programs, the 133% expansion could still come with significant costs, [one analyst] said. Not to mention that there is no guarantee that future congresses will continue to support the federal government footing most of the bill, he said (Walker, 7/2).

Meanwhile, it's not just the Medicaid expansion that state officials are thinking about -- exchanges are also getting consideration -

Kaiser Health News: States Already Taking Radically Different Approaches To Court Ruling
Three states – Mississippi, California and Texas -- illustrate the range of approaches emerging in the wake of the court's ruling. Here are the dispatches from NPR member station reporters (7/2). 

Modern Healthcare: GOP Tells Governors Not To Set Up Exchanges
GOP lawmakers in both chambers started their July 4 recess by asking the nation's governors not to implement the state health insurance exchanges required under the Patient Protection and Affordable Care Act. Reps. Michele Bachmann (R-Minn.) and Jim Jordan (R-Ohio) along with Sen. Jim DeMint (R-S.C.) have sent a letter to all 50 governors that urged the state leaders to oppose creating state exchanges that the federal lawmakers say impose a financial threat to strained state economies (Zigmond, 7/2).

Minnesota Public Radio: Bachmann And Conservatives Ask Governors To Reject Exchanges
With the Supreme Court's ruling last week to uphold the Affordable Care Act, conservative opponents of the law lost their main line of argument that the ACA was an unconstitutional expansion of government power. Now, with the help of Republican U.S. Michele Bachmann, they're urging governors to slow the implementation of the law by refusing to create the online health insurance markets known as exchanges that are one of the ACA's key policies. In a letter sent to all 50 governors, Bachmann and other tea party-linked members of Congress argue that "implementation of this law is not inevitable" (Neely, 7/2).