Perry rejects Medicaid expansion, opts not to create state-run health exchange

Gov. Rick Perry's announcement that Texas will not pursue either of these two elements of the federal health law is drawing both national and regional headlines. But other GOP governors are delaying and mulling these decisions. 

The Associated Press: Gov. Perry Tells Feds Texas Won't Expand Medicaid
Gov. Rick Perry said Monday that Texas won't establish an online marketplace for patients to shop for insurance or expand Medicaid, two key elements of the federal health care overhaul. In a letter sent to U.S. Health and Human Services Secretary Kathleen Sebelius, the Republican governor and former presidential candidate said both elements "represent brazen intrusions into the sovereignty of our state" (Stengle, 7/9).

Los Angeles Times: Texas Rejects Two Pillars Of New Federal Healthcare Overhaul
Texas turned down an expansion of Medicaid coverage and said it will not create a state-run healthcare insurance exchange, joining the chorus of states that are rejecting two key proposals of the Obama administration's healthcare overhaul measure. In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius released on Monday, Texas Gov. Rick Perry, whose bid for the GOP presidential nomination fell flat this year, rejected both healthcare proposals (Muskal, 7/9).

The New York Times: Perry Declares Texas' Rejection Of Health Care Law 'Intrusions'
Gov. Rick Perry of Texas told federal officials on Monday that the state had no intention of expanding Medicaid or establishing a health insurance exchange, two major provisions of President Obama's health care overhaul (Fernandez, 7/9).

Politico: Rick Perry: Medicaid Is Like Adding People To Titanic
Hours after sending a letter to the federal government saying he'll reject the exchanges and Medicaid expansion in the health care reform law, Texas Gov. Rick Perry compared the Medicaid program to a famous shipwreck (Smith 7/19).

Reuters: Texas Rejects Key Provisions Of Obama's Health Law
Governor Rick Perry said on Monday Texas will not implement an expansion of the Medicaid program or create a health insurance exchange, placing the state with the highest percentage of people without insurance outside key parts of President Barack Obama's signature law. The announcement makes Texas the most populous state that has rejected the provisions. Some 6.2 million people are without health insurance in Texas, or 24.6 percent of the state population, the highest percentage in the nation (MacLaggan, 7/9).

Houston Chronicle: Perry Dismisses Medicaid Expansion, Says Options Under Review
As Gov. Rick Perry stood defiantly against expanding Medicaid in Texas under the federal health-care reform law Monday, he and other officials said they'd work for alternative solutions in a state where a quarter of the people are uninsured. What those solutions would look like is unclear, although Perry has long called for the federal government to give money to Texas in block grants with fewer spending restrictions. Some suggested expanding federal subsidies for private insurance, to allow more low-income people to purchase insurance on the private market (Fikac, 7/9).

Dallas Morning News: Texas Insurance Exchanges Will Be Made In Washington
If there's going to be a Texas marketplace where individuals and families can get subsidized health insurance, it will be made in Washington. Gov. Rick Perry's decision Monday to opt out of the process leaves it to the federal government to design an insurance exchange for the state, selling federally designed insurance policies. The Supreme Court has upheld the constitutionality of requiring everyone to buy health insurance. Exchanges are the markets that will enable them to get those policies, with the cost offset for many buyers by federal tax credits. Small businesses will be able to shop for insurance on separate exchanges (Landers, 7/9).

Dallas Morning News: Perry Move On Medicaid Strips Hospitals Of Health Law's Major Benefit
Hospitals supported the Affordable Care Act because it contained a trade-off they could accept: The law would provide coverage to millions of uninsured people, even as it cut government payments to hospitals. If the Legislature goes along with Gov. Rick Perry's decision to reject much of the coverage expansion, Texas hospitals will face the prospect of huge Medicare and Medicaid funding cuts without as many new paying customers. The Medicaid expansion would provide insurance to as many as 1.7 million low-income Texans who are currently uninsured, according to the Urban Institute (Michaels, 7/9).

Dallas Morning News: Perry's Rejection Of Medicaid Expansion Could Burden Local Taxpayers
Soon after Perry fired off a no-thanks-ma'am letter to U.S. Health and Human Services Secretary Kathleen Sebelius and a statement denouncing President Barack Obama's signature health care law as a "power grab," health providers said they'd like to see the governor's plan for whittling into the state's towering problem of the uninsured. Perry didn't offer one, though he expressed confidence that state officials would do far better if they could use the $18 billion of federal Medicaid funds the state receives each year without conditions (Garrett, 7/9).

Meanwhile, other governors consider their options -

CQ HealthBeat: States Will Be Ground Zero For Medicaid Politics, Experts Predict
The federal health care law always envisioned a prominent role for states in the quest to expand coverage. But the Supreme Court's surprising ruling that upheld the law but allowed states to opt out of its Medicaid expansion now also promises political fights, intense health stakeholder lobbying and pressures galore in state capitals, panelists at an Alliance for Health Reform briefing said Monday. How many states eventually bow out of the expansion remains uncertain -; despite promises to do so by some Republican governors. And what happens will depend greatly on how and whether partisan control changes in state houses after the elections, panelists said. The latest governor to declare his intention to out opt was Republican Rick Perry of Texas, joining at least a half-dozen others (Norman and Adams, 7/9).

The Wall Street Journal's Metropolis: Christie Delays Decisions On Health-Care Law
Christie said [he] plans to make up his mind on authorizing state-run exchanges where people can buy health insurance and an expansion of Medicaid by the beginning of 2013. But his wait-and-see approach already separates him from some other prominent Republican governors, including Rick Perry of Texas and Rick Scott of Florida, who have already declared their intention to turn down new federal funds that would help insure more people under Medicaid (Grossman, 7/9).

Politico: Chris Christie: Health Care Was 'Extortion'
New Jersey Gov. Chris Christie labeled the Medicaid penalty in the Affordable Care Act "extortion," saying that he was pleased the Supreme Court ruled against that kind of approach "even when done by the president of the United States. First of all, I was glad that the Supreme Court ruled that extortion is still illegal in America -; and that's a relief because Obamacare, on Medicaid to the states, was extortion," he said Monday during a question and answer period after a speech at the D.C.-based Brookings Institution (Mak, 7/10).

Arizona Republic: Brewer Weighs Opting Out Of Medicaid Expansion
As Texas Gov. Rick Perry becomes the sixth GOP governor to say his state will opt out of the federal health-care law's Medicaid expansion, health-care providers, patients and business owners in Arizona are anxiously waiting to see whether Gov. Jan Brewer will follow suit. Representatives of Brewer said Monday that she is still gathering information about the scope, expense and federal requirements that would accompany an expansion of Medicaid in Arizona (Alltucker and Reinhart, 7/9).

Politico Pro: Wisconsin: No Medicaid Expansion-;For Now
Wisconsin Gov. Scott Walker's top health official said the state won't take up the Affordable Care Act's now-optional Medicaid expansion. After November, though, it could be another story. Wisconsin health Secretary Dennis Smith, a nationally recognized conservative voice on health care, said Monday it doesn't make sense for Wisconsin to immediately commit to the Medicaid expansion, not with so many questions about the program's implementation and anticipated federal deficit talks. But unlike officials in some of other states that have emerged as major "Obamacare" enemies,  Smith didn't say "never ever" to the Medicaid expansion (Millman, 7/9).