Will governors support the healthcare expansion?

June 29, 2012

The Supreme Court’s decision to uphold the Affordable Care Act just created an unenviable task for governors across the country.

To grant healthcare coverage to all Americans, the ACA involves an expansion of Medicaid, a program jointly funded by the federal and state governments and administered by the states for the poorest Americans. Under the expansion, an estimated 18 million people who previously lacked health insurance will be swept into the Medicaid program. Even though the federal government will bear the full cost of this expansion in the first year and 90 percent of it in subsequent years, states will shoulder some of the program’s administrative costs.

Adding 18 million people to the Medicaid rolls is a challenge in itself, but it also comes amid fears that Congress will decide to cut spending on social programs like Medicaid as a way to decrease the federal deficit. Wary of unfunded mandates like this one, some governors are hinting that they will refuse to expand healthcare coverage under the Medicaid program despite the federal government’s offer to pay for nearly all of it:

Michael Cooper at the New York Times has the clearest view of the situation:

Traditionally the promise of a big new stream of federal aid has been sufficient to persuade states to adopt new programs. But in recent years Republicans governors in Ohio, Florida, Wisconsin and New Jersey have turned down billions of dollars in federal money for transportation projects, arguing that the spending was unaffordable. Now the debate will center on whether they will accept federal money to expand health care coverage for the uninsured.

Republican governors have been arguing for the federal government to distribute Medicaid funds as block grants and remove many of the requirements of coverage that current law requires. You can be sure that the SCOTUS ruling is issue number one in every statehouse today. Stay tuned.



AP: Where states stand on implementing healthcare law

Kaiser Foundation: State Adoption of Key Medicaid Options Provided by the Affordable Care Act, 2012

Multistatelawsuit.com: States filing against the healthcare law

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