Governors stake out political and policy positions on Medicaid expansion

During the National Governors Association meeting this past weekend in Williamsburg, Va., the nation's state executives continued to wrestle with what to do in the wake of the Supreme Court's decision.

Reuters: At Annual Meeting, U.S. Governors Come Out Swinging Over Medicaid
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 health care 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 (Lambert, 7/14).

Reuters: Analysis: U.S. Governors Make Risky Political Bet On Health Care Funds
Republican governors bent on rejecting the health care law's expanded insurance coverage for millions of low-income Americans may see their gambit backfire if their party fails to sweep the November elections. Five governors have vowed to opt out of the Medicaid expansion for low-income people since the Supreme Court's June 28 landmark health care ruling let states decide whether to participate in the program. Several others, saying the program will be a huge financial burden on states, are leaning toward the same action (Morgan, 7/15).

The Washington Post: Why Republican State Leaders Are Resisting Medicaid Expansion
The expansion of Medicaid called for in President Obama's health care law would seem an irresistible deal for states: Starting in 2014, in exchange for spending a percent or two more of their own funds, states will get nearly a trillion additional federal dollars during the next 10 years to extend health insurance to 17 million of their neediest residents. So why are so many Republican state leaders balking? Increasingly they speak of two experiences that, they charge, raise questions about whether the federal government can be counted on to hold up its end of the bargain: Congress's decision not to fund a mandated increase in Medicaid pay rates for doctors beyond two years and Obama's recent willingness to consider cutting the federal contribution to Medicaid (Aizenman, 7/13).

The New York Times: Many Governors Are Still Unsure About Medicaid Expansion
How well the new health care law succeeds in covering millions of the poorest Americans will depend largely on undecided governors of both parties, who gathered here this weekend and spoke of the challenges of weighing the law's costs and benefits in a highly charged political atmosphere and a time of fiscal uncertainty. ... But as they gathered here this weekend at a meeting of the National Governors Association, most governors in both parties said that faced with a choice they did not expect to have, they needed to study how to proceed with this significant change in federal-state relations. Not all Democrats were leaping at the chance to expand their programs, and not all Republicans were ruling it out (Cooper, 7/14).

The Associated Press: Governors Put Off Health Care Questions, For Now
Millions of uninsured people may have to wait until after Election Day to find out if and how they can get coverage through President Barack Obama's health care law. More than two weeks after the Supreme Court gave the green light to Obama's signature legislative achievement, many governors from both parties said they haven't decided how their states will proceed on two parts under their control: an expansion of Medicaid, expected to extend coverage to roughly 15 million low-income people, and new insurance exchanges, projected to help an additional 15 million or so purchase private insurance (Lederman, 7/15).

Politico: GOP Governors Name Their Price On Health Care Law Expansion
Two dozen Republican governors fought all the way to the Supreme Court to win the right to reject President Barack Obama's expansion of Medicaid under the health care law. However, just a few weeks after the Supreme Court sided with them, some of these governors are leaving themselves an opening to expand Medicaid anyway -- but on their own terms. Five Republican governors said Friday they would consider expanding the program if the feds gave them Medicaid dollars in block grants, which has been a goal of Republicans since the 1990s (Cheney, 7/14).

Los Angeles Times: Governors Divided Over Medicaid Expansion
But a greater number of governors on both sides approached the unexpected ruling with caution, largely out of concern for the long-term effect on state budgets that had been stretched to the brink by the economic downturn. ... The ruling also opened the door for states inclined to participate to seek further concessions from the federal government in how an expansion might be structured. Ultimately, said Gov. Dave Heineman of Nebraska, a Republican and the association's outgoing chairman, "there are going to be 50 different state solutions" (Memoli, 7/14).

Politico: GOP Governors Say 'No' To Medicaid
Two Republican governors appear ready to turn down the Medicaid expansion now that the Supreme Court has given them a way out. Florida Gov. Rick Scott and Iowa Gov. Terry Branstad both attacked the Obama Medicaid requirements to cover millions of lower-income families, saying their states couldn't afford it. "I don't want to embark on something that is unaffordable," Branstad said on "Fox News Sunday" (Raju, 7/15).

The Hill: Republican Govs. Scott, Branstad Balk At Accepting Health Law Medicaid Expansion
Two Republican governors in key battleground states said on Sunday they are pushing to reject matching the federal government's expansion of Medicaid under President Obama's new health care law. Florida Gov. Rick Scott and Iowa Gov. Terry Branstad balked at the idea of expanding their states' Medicaid ranks, saying that their budgets cannot take on additional entitlement spending. "This is just another government program where the federal government will run out of money and they'll put it on the states again," said Scott on Fox News Sunday (Yager, 7/15).

NPR: Eyes On Election, Governors Hedge On Health Care
As governors from around the country meet this weekend in Williamsburg, Va., health care is near the top of their agenda. Specifically, what to do about the federal health law, now that the Supreme Court has given states new options. Republican governors in particular said they were genuinely surprised by the Supreme Court ruling. The justices declared the health law in general constitutional, but gave states the option of whether or not to dramatically expand their Medicaid programs (Rovner, 7/15).

The Washington Post: DGA Chairman O'Malley On Medicaid Expansion: 'Each Governor Has A Unique Set Of Challenges'
So what does the chairman of the Democratic Governors Association make of the fact that in more than half a dozen states, Democratic governors are waiting to make a decision on whether they'll implement a key aspect of President Obama's signature health-care law? "Every governor has a unique set of challenges; some have greater political challenges to overcome than others," DGA chairman and Maryland Gov. Martin O'Malley told reporters Saturday at the National Governors Association annual meeting. While seven Democratic governors have yet to make up their minds on the Medicaid expansion, 22 Republican governors are undecided, as well (Sonmez, 7/14).

Politico: McDonnell Hammers Medicaid Expansion
Virginia Gov. Bob McDonnell denied on Sunday that his Republican peers were "playing politics" by rejecting the Affordable Care Act's Medicaid expansion, arguing the expansion was fiscally irresponsible. "Expanding Medicaid without fixing Medicaid is a terrible idea," McDonnell, a Republican, said on CNN's "State of the Union" (Reis, 7/15).

Meanwhile, the message from the Obama administration --

Politico Pro: Tavenner: No Deadline For Medicaid Opt-In
CMS Acting Administrator Marilyn Tavenner told governors Friday that states won't have a deadline for opting in to the health care law's Medicaid expansion. Tavenner didn't address many of the 30 questions Republican Governors Association Chairman Bob McDonnell asked earlier this week in a letter about the health care law. But she emphasized that "the court's decision did not affect other provisions of the law" besides the Medicaid expansion (Smith, 7/13).

The Hill: White House To States: Time To Get On Board With Health Care Reform
The Obama administration is aggressively pushing states to implement the health care reform law now that the Supreme Court has upheld it. In the two weeks since the court issued its decision, the Health and Human Services Department has pushed out new grants, new policies and a new rhetorical standby: It's time to get onboard. "The volume of activity has certainly gone up," said Alan Weil, executive director of the National Academy for State Health Policy (Baker, 7/15).