An increasing number of Republican governors say they will keep their states out of the federal health care law's massive Medicaid expansion, a week after the Supreme Court opened the door for states to opt out without jeopardizing federal dollars they already receive.
Shortly after the ruling was announced, a number of GOP governors who are prominent critics of President Obama's health care law reveled in the court's Medicaid decision, the sole victory for the health law's opponents. Republicans such as Governor Bobby Jindal of Louisiana and Wisconsin Governor Scott Walker were quick to say they wouldn't implement any part of the federal law, and would work for its repeal.
The Obama administration has dismissed the idea that states will walk away from the federal money that comes along with the Medicaid expansion. But The Hill newspaper says Republican lawmakers and Medicaid officials in at least 15 states have pledged to do just that.
These states would forfeit billions in federal aid and decline health coverage for millions of their uninsured residents. The Medicaid expansion is intended to cover as many as 17 million people – nearly half the law's total increase in coverage – and Washington would pay the entire cost from 2014 to 2017, and 90 percent after that.
Still, that arrangement hasn't dulled the criticism from some state executives, particularly those skeptical of adding any more costs to a Medicaid program that is already eating up a significant chunk of state budgets.
“Here's the problem,” Iowa Governor Terry Branstad said, according to the Des Moines Register. “The federal government has done this again and again: ‘Buy into our program and we're going to do all these things for you.'”
“Then it doesn't happen,” he added, “and then the taxpayers of the state get stuck with it.”
Even some officials who believe the federal government will fulfill its financial promises say they will opt out of the Medicaid expansion. Texas, for example, has put its estimated costs from the expansion as high as $27 billion over the first decade, a figure officials call too steep for its budget. And Florida Governor Rick Scott said Monday even 10 percent of the cost was too much for his state to bear.
“Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program,” Scott announced. He said the state's Medicaid spending was already “growing three-and-a-half times as fast as Florida's general revenue.”
How much each state might spend, and how much its Medicaid rolls might increase, under the law has been up for debate since it was signed. The New York Times compiled data this week from the Kaiser Family Foundation which projects how the Medicaid expansion would affect federal and state spending in each state. According to Kaiser, most states opting into the expansion would have to ramp up their Medicaid spending between 2014 and 2019, but four would spend less (Hawaii, Maine, Massachusetts and Vermont) and several others would have to boost state spending only slightly.
Even those estimates depend on assumptions of how many newly eligible people will enroll in the Medicaid expansion. According to a 2010 Kaiser Family Foundation report, states' share of the Medicaid expansion could range from $20 billion to $43 billion in the first five years, depending on how many people ultimately enroll.