Health law's Medicaid expansion raises possibilities, problems for states

California Gov. Jerry Brown describes implementing the expansion as "incredibly complex," while Michigan Gov. Rick Snyder sees it an opportunity to address gaps in the mental health system. In Arizona, meanwhile, the expansion is framed as an immigration issue.

Los Angeles Times: Gov. Jerry Brown Calls For Special Session Of Legislature On Healthcare
Healthcare and education reform were key themes of Gov. Jerry Brown's State of the State address Thursday in which he called for the Legislature to convene a special session to work out issues involving the state's compliance with the federal Affordable Care Act. "Our health benefit exchange, called Covered California, will begin next year providing insurance to nearly one million Californians," Brown said. "Over the rest of this decade, California will steadily reduce the number of uninsured." But he said it will be "incredibly complex" to implement a broader expansion of Medi-Cal called for by the federal law (McGreevy, 1/24).

State Of Health: Gov. Brown's State Of The State – On The Health Care Overhaul
In his State of the State speech Thursday morning, Gov. Brown spent about 60 seconds addressing health and human services -; and all those seconds were devoted to the rollout of the Affordable Care Act. Early in his speech, Brown reiterated his theme of fiscal discipline and seemed to urge caution in implementing the Affordable Care Act, stating, "The ultimate costs of expanding our health care system under the Affordable Care Act are unknown. Ignoring such known unknowns would be folly." … Let's take these two items one at a time, starting with the health benefit exchange. Brown is calling for a special legislative session so that new laws necessary to implement the exchange can take effect more quickly. That speed is necessary since the exchange must open for people to enroll on October 1. Health insurance purchased in the exchange will start on January 1, 2014 (Aliferis, 1/24).

The Associated Press: Snyder Eyes Mental Health Makeover, GOP Skeptical
Gov. Rick Snyder's plan to fill the gaps of Michigan's mental health care system might lie in his ability to convince lawmakers on both sides of the aisle to expand Medicaid to provide 500,000 Michigan residents with coverage under the federal Affordable Health Care Act. Snyder, a Republican, told the Associated Press on Wednesday that it would "actually expand mental health coverage significantly" and that it is "one of the factors" he is "taking into account." Snyder said he will "make that call" during his budget presentation Feb. 7 (Durkin, 1/25).

The Washington Post's Wonk Blog: Arizona Could Make The Medicaid Expansion An Immigration Fight
Arizona Gov. Jan Brewer's decision to participate in the Medicaid expansion was a puzzling one: Why would one of the nation's most conservative governors opt into an Obamacare program that most of her Republican colleagues have rejected? New budget memos from the state provide some insight: Opting out of the Medicaid expansion had the potential to give immigrants better access to health care than American citizens. This small quirk in the Affordable Care Act that Arizona stumbled on could significantly reshape the politics for governors weighing whether to sign up for the health law's Medicaid expansion (Kliff, 1/24).

Dallas Morning News: Quirk In Health Care Law Could Set Up Tough Choice For Rick Perry On Medicaid
A glitch in the federal health care law could put Gov. Rick Perry over a political barrel. Under President Barack Obama's signature measure, some legal immigrants will receive subsidies to help buy private insurance next year. But thanks to a legal quirk and an unexpected twist from the Supreme Court, hundreds of thousands of poor Texans who are U.S. citizens stand to get nothing if Perry and state GOP leaders follow through in refusing a mostly federally paid expansion of Medicaid. The prospect that immigrants, even legal ones, possibly could receive better treatment under the law than native Texans may not faze Perry, especially as he guards his right flank against a possible challenge by Attorney General Greg Abbott in the 2014 governor's race, said Rice University political scientist Mark Jones (Garrett, 1/24).

Also in the news related to state action and the health law --

Kaiser Health News: TurboTax, Not Travelocity, May Be Better Analogy For Health Exchanges
For years, we've been hearing that health insurance exchanges created by the Affordable Care Act are going to be 'online marketplaces, like Travelocity' where people will buy health policies like plane tickets. But a consumer focus group in Colorado suggests people are going to want something more like TurboTax (Whitney, 1/25).