Many Governors Still Weighing Reform Law’s Expansion of Medicaid

Governors attending the annual National Governors Association meeting Friday through Sunday largely avoided the issue of whether their state would participate in the Medicaid expansion under the Affordable Care Act, the New York Times reports (Cooper, New York Times, 7/14).

The recent Supreme Court ruling on the federal health reform law indicated that states can opt out of the ACA's Medicaid expansion without any effect on current funding. Observers noted that the attention paid to the issue at NGA's annual meeting could force undecided governors to reveal their position (Kumar, "Virginia Politics," Washington Post, 7/11).

Governors Avoid Discussing Medicaid Expansion Plans

The Los Angeles Times reports that even during a scheduled discussion on Saturday regarding controlling Medicaid costs, governors "largely sidestepped the issue" (Memoli, Los Angeles Times, 7/14).

Most governors attending the meeting said that the ruling presented them with a choice they did not expect to have and that they needed more time to study the economic effect of the high court's judgment. Even governors who have indicated they are leaning a certain way on the expansion "were keeping their options open," according to the New York Times (New York Times, 7/14).

According to the Los Angeles Times, the majority of governors said they would approach the decision "with caution," alluding to the long-term effect on their state's budget in the wake of the recent economic downturn (Los Angeles Times, 7/14).

Several governors indicated that they will wait to decide until after the presidential election (New York Times, 7/14).

Wisconsin Gov. Scott Walker (R) said, "We're not going to spend any taxpayer money or resources on a system that could very well be on the path to being repealed after Nov. 6." He was referring to a vow by presumptive Republican presidential nominee Mitt Romney to repeal the ACA on his first day in office (Los Angeles Times, 7/14).

The New York Times notes that even if governors make up their mind on the expansion, they could face a battle with the state legislature might impede progress (New York Times, 7/14).

GOP Govs. Fearful of Federal Pull-Out

Although the overhaul stipulates that the federal government would cover the entire cost of the expansion for the first three years and then 90% of the cost after that, a "handful" of GOP governors at the meeting said they thought federal officials would pull a "bait-and-switch" and ultimately lower the amount the federal government provides to states, according to the AP/San Francisco Chronicle.

Arizona Gov. Jan Brewer (R) said, "At any whim they could just pull the money," adding, "So yeah, I'm a little gun shy" (Lederman, AP/San Francisco Chronicle, 7/15).

That concern was echoed by other GOP officials.

Florida state Sen. Joe Negron (R) said, "Today Washington may pay. But what's going to happen when reality sets in and they realize they can't continue to run up the nation's credit card?" He added, "I think ultimately there's a very high likelihood that an additional burden will be placed on states" (Aizenman, Washington Post, 7/15).

Some GOP Govs. Say More 'Flexibility' in Medicaid Could Convince Them

A number of Republican governors at the NGA meeting said that if the Obama administration were to give them more "flexibility" in running Medicaid, they might be more inclined to accept the expansion, Politico reports.

Five GOP governors -- Nebraska Gov. Dave Heineman, Tennessee Gov. Bill Haslam, Utah Gov. Gary Herbert, Virginia Gov. Bob McDonnell and Wyoming Gov. Matt Mead -- all said that they could change their mind on their opposition to the expansion, in the right circumstances. All said they would consider expanding the program if federal officials provided their state with block grants for Medicaid.

Herbert said, "They ought to be giving all states more flexibility, block grant the money and let us find our own unique ways with our own unique populations and demographics to find the best way to provide health care" (Cheney, Politico, 7/14).