Court ruling could let states cut Medicaid rolls; More states weigh opting out of expansion

The Supreme Court decision overturning the requirement that states expand their Medicaid programs is whipping up strong emotions in some state capitals.

Kaiser Health News: States Could Cut Medicaid Rolls In 2014 As A Result Of Court Ruling
Starting in 2014, things could get worse for people in Medicaid. Not only could some states opt out of increasing the number of adults in the government health insurance program for the poor as a result of the Supreme Court's ruling, but they also could cut people now enrolled (Galewitz, 7/3).

The Washington Post: More State Leaders Considering Opting Out Of Medicaid Expansion
A growing number of Republican state leaders are revolting against the major Medicaid expansion called for under President Obama's health-care overhaul, threatening to undermine one of the law's most fundamental goals: insuring millions of poor Americans. ... The Republican governors of four states -; Florida, Iowa, Louisiana and South Carolina -; have declared that they want to opt out of the expansion. Leaders of half a dozen other states -; including Texas, home to one of the largest concentrations of uninsured people -; are considering following suit (Aizenman and Somashekhar, 7/3).

Associated Press: 2 Paths Forward For Uninsured, 1 Clouded By Ruling
Really? The Supreme Court's big health care decision means 30 million or more uninsured Americans are soon going to have coverage? It's far from that simple. ... the path is clouded for millions more: the people on the bottom rungs of the economic ladder who are supposed to be reached by a major expansion of Medicaid. Thanks to last week's ruling on President Barack Obama's overhaul, states can opt out of the expansion without fear that Washington will shut down all their federal Medicaid financing. And if some states do opt out, a lot of their residents are going to have to find another way to get coverage, or continue to go without (Alonso-Zaldivar, 7/3).

Politico Pro: Lawmakers Could Clash Over Medicaid
Governors may not have the last word on whether states expand Medicaid in 2014. Legislatures may also have some strong opinions on whether to accept or reject billions of federal dollars the Affordable Care Act provides to help insure about 17 million of their poorest constituents. The disputes may be most intense in the states with divided government. But the same dynamic may play out elsewhere. "Usually, anything that involves as much money as Medicaid, the governor isn't able to just make independent decisions," said Joy Johnson Wilson, health policy director for the National Conference of State Legislatures. "Different states have different procedures and all, but it matters how it affects the state budget" (Cheney, 7/5).

Politico Pro: Hospitals Say No Medicaid, No Revenue Cuts
Before the Supreme Court's health care decision, hospitals warned that if the individual mandate died, so would the $155 billion deal they cut with the White House that traded expanded coverage for cost reductions. The mandate stayed, of course. And hospital groups have revived a slightly altered version of that message. If Medicaid expansion doesn't happen, the deal is off. See a trend? For hospitals, "the primary driving force has always been coverage," said one health care lobbyist. "All the other reforms are good, but coverage is what [they're] about. The Medicaid ruling puts that coverage expansion in jeopardy" (DoBias, 7/5).

Politico Pro: Private Medicaid Plans On Track After Ruling
Even as Republican governors are talking tough about backing out of the health care law's Medicaid expansion, the private Medicaid plans that could potentially lose millions of new customers aren't sweating the sudden loss of guaranteed business in 2014. The expanded Medicaid program, before the Supreme Court gave states an out, would have amounted to $356 billion over 10 years for Medicaid insurers, according to a Supreme Court amicus brief submitted by the American Action Forum's Douglas Holtz-Eakin and more than 100 conservative economists and health wonks (Millman, 7/3).

In some state capitals, the political fight over the Medicaid expansion is beginning to take form.

St. Louis Beacon:  Nixon Attracts National Spotlight As Missouri Lawmakers Prepare To Battle Over Medicaid
Gov. Jay Nixon, a Democrat, already is under pressure from Republican legislators who vow to oppose any expansion of Missouri's Medicaid program, as called for under the federal Affordable Care Act, which was largely green-lighted last week by the U.S. Supreme Court.  But now, he's a target on his left flank as well (Mannies, 7/3).

The Denver Post:  Colorado's Tab For Medicaid Expansion Still A Troubling Mystery
Colorado's tab for the pivotal Medicaid expansion in health-care reform could be hundreds of millions of dollars in the first few years, worrying Republicans and testing analysts' aid models (Booth, 7/5).

And many states' plans for the health insurance exchanges are still in flux too.

Associated Press: Christie May Let U.S. Run N.J.'s Health Exchange
Gov. Christie said he was considering letting the federal government set up the state health insurance exchange required by the federal health-care overhaul to allow individuals to buy coverage. He also said he was not sure New Jersey needs to expand Medicaid under the federal law because the state's program that covers the poor and disabled already is extensive (7/4).