Expansion debate, decisions play out in Va., Ga., Texas

As state legislators and governors wrestle with budget issues and health law implementation decisions, the role of the Medicaid expansion is shaping up in different ways in different locations.

The Washington Post: Va. Assembly Showdown Over Medicaid Expansion Threatened
One day after House and Senate negotiators struck a transportation funding deal, some Democrats were trying to link passage of that plan to the issue of Medicaid expansion. Some House Democrats vowed to vote against the transportation package if the General Assembly does not lay the groundwork this year for expanding Medicaid. They are also threatening to vote against state budget amendments if they do not include a framework for expansion (Vozzella and Kunkle, 2/21).

Richmond Times-Dispatch: Showdown Looms Over Transportation, Medicaid
The two most important issues before the General Assembly -; new funding for transportation needs and expansion of Medicaid -; could converge today in a tense political showdown prompted by a letter from Gov. Bob McDonnell that may undermine his biggest legislative priority. The letter, vowing not to consider expansion of Medicaid in Virginia if it would increase "the immoral national debt," prompted Senate Democrats to threaten on Thursday to withhold support for the transportation package endorsed by McDonnell and Republican legislative leaders, while House Democrats vowed not to support the proposed budget without the Medicaid expansion (Nolan and Martz, 2/22).

Atlanta Journal-Constitution: Georgia Gov. Deal Unswayed By Florida's Switch On Medicaid
Florida's Rick Scott this week became the seventh Republican governor to embrace a key element of the federal health overhaul by enrolling more poor people in Medicaid. Don't expect Gov. Nathan Deal to make it eight any time soon. Deal, also a Republican, has remained outspoken in his refusal to expand Medicaid coverage to at least 650,000 more Georgians, citing the budget woes already facing the government health program. He said the state's share of the cost of expanding Medicaid - a projected $4.5 billion over a decade - would be too great. "My position hasn't changed," Deal said Thursday. "Our financial situation hasn't changed either. It is on that basis that I made my judgment call." Still, he said, he's interested in talking with Scott and other GOP governors about why they made their decisions (Bluestein, 2/22).

The Texas Tribune/New York Times: At A Loss On Refusing Medicaid Cash
State officials, starting with Gov. Rick Perry, want the state to stay away from any expansion outlined in the federal Affordable Care Act. They object to creating an entitlement program where none currently exists, because they say they fear it will grow into a money-gobbling monument to big government -; socialism, even. Besides, they say, Texas doesn't have enough doctors and other medical professionals to provide care for the newly insured (Ramsey, 2/21).

The Texas Tribune: After Florida Medicaid Reversal, Hints Of Compromise In Texas
Florida Gov. Rick Scott announced on Wednesday that he would accept an expansion of Medicaid under the Affordable Care Act. The decision leaves Texas as the last big-state holdout. In a statement on Wednesday, Gov. Rick Perry reiterated his stance on the expansion, saying it would be "to add more Texans and dump more taxpayer dollars into an unsustainable system." State Sen. Jane Nelson, R-Flower Mound, has a slightly softer stance. "I'm opposed to any expansion of Medicaid that doesn't give Texas the flexibility that we want" (Philpott, 2/22).

Also in the news related to the health law's implementaiton -

The Hill: HHS: Most States On Track With Health Law's Technical Demands
Thirty-five states will be ready with new healthcare eligibility and enrollment systems by Jan. 1 of next year, according to a new federal report. The Health and Human Services (HHS) Inspector General surveyed states in March and April 2012 about their readiness to comply with a variety of technical requirements under President Obama's healthcare law (Viebeck, 2/21).

California Healthline: Historic Week In Health Reform
California has been working on health care reform for years, but this week's legislative special session had that distinctive sound of a starting gun for the last, big dash toward the Affordable Care Act finish line. … This week's work included committee passage of a streamlined eligibility and enrollment process, which is likely to sail through the Legislature. The other big piece of legislation created more controversy. The adoption of a plan to establish geographic rating areas for the individual and small group health insurance market was accompanied by media reports of premium rate increases of 20 percent or higher. Insurance Commissioner Dave Jones proposed a different type of geographic breakdown that he said would cut down on those rate increases (Gorn, 2/22).

The Associated Press: Idaho Gov. Otter's Insurance Exchange Plan Gets Backing From State Senate
Idaho senators voted Thursday to back the governor's plan to create a state-based nonprofit insurance exchange, rather than defaulting to an exchange run by the federal government, as many other Republican-led states have done. The 23-12 vote after six hours of debate marked a key milestone for Gov. C.L. "Butch" Otter's bill. The GOP governor contends the proposal will result in a marketplace for individuals and small businesses to compare and buy insurance that's less expensive and friendlier to Idaho insurers and agents than what Washington, D.C., would come up with (2/21).