States, especially GOP-controlled ones, facing crucial decisions on health insurance exchanges, Medicaid

Stateline: Obama Win Means Big Health Care Decision For States
Since the day it was enacted, many of the Affordable Care Act's opponents have preferred to treat it as provisional. ... there remain some significant uncertainties in the immediate future of the ACA, particularly in how Republican governors, who have vociferously opposed the law until now, will react in the wake of President Obama's victory. The ACA is indeed the law of the land and will remain so for the foreseeable future, but that doesn't mean that Republican governors have to be full participants (Vestal and Ollove, 11/8).

The Hill: Analysis: 20 States Will Run Their Health-Law Exchanges
Twenty states will operate their own insurance exchanges in 2014 under President Obama's healthcare law, according to a new analysis. Avalere Health released its estimate after Obama won a second term on Tuesday, ... Governors have a choice as to whether to implement the law's exchanges or leave the task to the federal government. A third option is a "partnership" model in which the state and federal government jointly manage the marketplace (Viebeck, 11/7).

Politico: States Face Swift Deadline On Health Exchanges
By Nov. 16, states must tell the Obama administration whether they plan to run at least part of their own health insurance exchanges, new state-based marketplaces that will provide subsidies for low- and middle-income individuals and small businesses to purchase coverage. Eventually, states also will have to decide whether they'll accept a larger expansion of Medicaid, which comes with a generous match from the federal government but still requires states to pony up some of their own money (Millman 11/8).

Kaiser Health News: State Political Shifts Likely To Affect Health Law
Republicans will have 30 governors and control 24 state legislatures next year, compared to 19 Democratic governors  and 18 Democratic-controlled legislatures. The rest are split or tied. The Medicaid expansion and new insurance exchanges are the key ways the health overhaul expands coverage to as many as 30 million people starting in 2014. But the Supreme Court in June gave states the option to decide whether to expand Medicaid in 2014 (Galewitz, 11/7).

Kaiser Health News: Maine May Warm To 'Obamacare' After Democratic Sweep
North of the Mason-Dixon Line, it's hard to find a state that has given more of a cold shoulder to President Barack Obama's health law than Maine. ... But Maine's voters may have short-circuited further resistance Tuesday by initiating a Democratic sweep that flipped control of both houses of the State Legislature, and is now poised to challenge Gov. Paul LePage, a tea party Republican opposed to the law (Galewitz, 11/8).

CQ HealthBeat:  After Election, Governors Face Medicaid Decision
So far, six GOP governors, all of whom remain in power, have said that they would not expand the health program for the poor (Adams, 11/7).

The Associated Press: Obama's Win Forces Walker's Hand On Health Care
President Barack Obama's re-election is forcing the hand of Wisconsin Gov. Scott Walker, who had stopped all efforts to implement the federal health care reform law in the hopes that Republicans would take over in Washington. ... Walker's administration and Republican leaders in the state Legislature are now scrambling to figure out their next move (Bauer, 11/7).

Milwaukee Journal Sentinel: Walker, Other Officials Have To Scramble On Obamacare Compliance
Walker decided late last year to stop planning to implement the health care law in the state, preferring instead to hold out for an Obama defeat and a repeal of the law (Stein, 11/7).

The Associated Press: Kan. Officials Ponder Next Health Care Step
Kansas officials are considering their next steps to implement the federal health care law now that the presidential election has been decided and deadlines are looming. The state has until Nov. 16 to tell the federal government whether it wants to be a partner in creating an online health insurance marketplace (Milburn, 11/7).

Kansas Health Institute News: Praeger Seeks Quick Insurance Exchange Answer From Governor
Kansas Insurance Commissioner Sandy Praeger said today that she wants to meet this week with Gov. Sam Brownback about how to move forward with implementation of the federal health reform law.  Specifically, Praeger said she wants to talk to Brownback about the state partnering with the federal government on a health insurance purchasing exchange (McLean, 11/7).

The Atlanta Journal-Constitution: Big Healthcare Decisions Loom For State In Election's Wake
Two major decisions loom for [Georgia] Gov. Nathan Deal and other Republican governors who have put off key decisions tied to the law, hoping it would be repealed if Mitt Romney won election. One is whether they to accept billions of federal dollars to expand Medicaid, the government health program for the poor. Deal's decision will determine whether hundreds of thousands of low-income Georgians get access to health coverage. To date Deal has said the state can't afford the expansion longterm (Williams, 11/7).

Georgia Health News: Health Care Law Lives – And Ga. Faces Big Choices
Still, there may be a middle ground between states rejecting [Medicaid] expansion and fully pursuing it, Custer said. Some states have approached the federal government about a partial expansion, up to 100 percent of the federal poverty rate, rather than up to 138 percent ($15,415 for an individual; $26,344 for a family of three in 2012) as currently required (Miller, 11/7).

North Carolina Health News: In Wake Of Election, Questions About NC's Implementation Of Health Reform
One of the questions that's been open during this campaign season in North Carolina has been the fate of the state's Medicaid program. ... Although some in the General Assembly have balked at the price tag, the political backlash of not covering a big chunk of North Carolina's 1.5 million uninsured may be too great. And the state's hospitals stand to lose big if a Medicaid expansion does not go forward (Hoban, 11/7).

Health News Florida: FL To Miss Exchange Deadline
[L]ike a kid who didn't do his homework, the state's about to miss an important deadline in implementation of the Patient Protection and Affordable Care Act. On Nov. 16 -- in just eight days -- states are supposed to turn in the applications and blueprints for their health insurance exchanges. ... Even if Gov. Rick Scott had a change of heart and wanted to send in an application, the Legislature hasn't given him the authority (Gentry, 11/8).

Richmond Times-Dispatch: Va. To Use Federal Health Exchange Option – For Now
[Gov. Bob] McDonnell said he would default to a federal exchange with the understanding that the state could change course later. … Defaulting to a federal exchange would reverse the position that McDonnell and the General Assembly took last year, when he signed a law giving him the authority to plan for implementing a state-based health benefits exchange under the Patient Protection and Affordable Care Act (Martz, 11/7).

MPR: Election Likely Removes Obstacles To Health Care Overhaul In Minn.
Democrats now control the capitol, led by Gov. Mark Dayton, who solidly supports the president's health care overhaul. ... Consultant Joel Ario, who formerly headed the U.S. Department of Health and Human Services' Office of Health Insurance Exchanges during the Obama administration, said Minnesota is well ahead of most other states. "I expect Minnesota will be one of the first states to be approved for a state-based exchange," Ario said (Stawicki, 11/8).

Health Policy Solutions (a Colo. news service): Now In Control, Colorado Democrats Want Medicaid Expansion
"We would like to push to get health care to as many people as possible because that's going to reduce the costs for everyone," said Rep. Mark Ferrandino, D-Denver, who is expected to take the reins of the Colorado House in January after Democrats recaptured control of it on Tuesday. Gov. John Hickenlooper is more circumspect. While he supports expansion of health care, Hickenlooper refused to say whether he'll support Medicaid expansion (Kerwin McCrimmon, 11/7).

Los Angeles Times: California Speeds Revamp Of Health Insurance Market
With President Obama's reelection lifting a potential roadblock, California officials are rushing to implement the federal healthcare law and revamp the insurance market for millions of Californians starting next fall. ... Wednesday, California officials disclosed plans to spend nearly $90 million next year on marketing and outreach to millions of consumers who may become eligible for premium subsidies and other assistance under the federal law starting in 2014 (Terhune, 11/7).

California Healthline: December Special Session Now 'Full Steam Ahead'
The nation's re-election of Barack Obama means California lawmakers will have a much busier and more productive special legislative session in December, according to state lawmakers. Gov. Jerry Brown (D) called for the December special session as a way to make sure California is fully on board with implementation of the Affordable Care Act. … Issues to address in the special session … include reform of the individual health insurance market (Gorn, 11/7).

California Healthline: Prop. 30 Could Stem Health Care Costs
Although revenues from Prop. 30 will help fund education, if it hadn't passed on Tuesday, the Legislature would be facing yet another massive budget shortfall and lawmakers would need to look at cutting many more millions of dollars. Health care programs and services would've been on the chopping block once again (Gorn, 11/8).

The Associated Press/Dallas Morning News: After Election Texas Legislature Faces Tough Issues Ahead
Texas Republicans will go into the 2013 legislative session with much of the same agenda as last year: tackle government spending, tighten immigration laws and discourage abortion. … The first order of business will be to make up for a $4.3 billion budget deficit by March, when funding will run out for Medicaid, the health care for the poor, elderly and disabled. Comptroller Susan Combs has forecast $5 billion in unexpected revenue this two-year budget cycle, so covering the tab should be relatively easy. The next two-year budget, though, will present a bigger challenge, with the Department of Health and Human Services expecting Medicaid costs to increase more than $7 billion (11/7).