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Affordable Health Care Act—What Are States Doing?

The country remains divided on whether the Affordable Health Care Act is good for states; whether it will cost more (or less); and whether the states will implement the Medicaid provisions as ruled by the Supreme Court.

Interestingly, some think states that are most against the Act will benefit the most. “Red states have, in general, done less than blue states to cover their residents, so they’re going to get a sweeter deal under the terms of the Affordable Care Act,” said Ezra Klein, a blogger for The Washington Post.

The federal government currently pays 57 percent of Medicaid costs, meaning the Affordable Care Act offer [100% for the first few years, then reduced to 90% federal payment] is “an incredibly, astonishingly, unbelievably good deal” for those states, Klein said.

So what are states doing? Many are still reviewing the law, the Supreme Court ruling, and their options. Here is a quick review of nine states across the country who made the news this week:

California

Former Gov. Arnold Schwarzenegger proclaimed: “I have always supported the need for comprehensive health reform. However, for healthcare reform to succeed, states must either have the flexibility to live within the revenues that are available to them or the federal resources to fully fund its mandates.”

The big cost to the state will be for a generous expansion of Medi-Cal, California’s version of Medicaid.

Because California can’t even afford its current Medi-Cal program, it has been cutting back on poor people’s care in recent years. The 2012 state budget passed last month included more than $1 billion in cuts to Medi-Cal and other health programs.

Still, the Brown administration is moving toward the act’s implementation. In fact, it already has begun covering 280,000 people. “This is a very great day,” state Health and Human Services Secretary Diana Dooley declared. “We are in the full-go mode here.”

As George Skelton of the Capitol Journal writes, “But it’s another state cost that no one is considering how to pay for — not nearly as extravagant as the mostly unfunded bullet train, but the same basic idea: meritorious, but moneyless.”

Texas

Gov. Perry: Texas Will Not Expand Medicaid or Implement Health Benefit Exchange.

“If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under Obamacare,” Gov. Perry said. “I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government.

From Governor Perry’s Webpage: “Gov. Perry has frequently called for the allocation of Medicaid funding in block grants so each state can tailor the program to specifically serve the needs of its unique challenges. As a common sense alternative, Gov. Perry has conveyed a vision to transform Medicaid into a system that reinforces individual responsibility, eliminates fragmentation and duplication, controls costs and focuses on quality health outcomes. This would include establishing reasonable benefits, personal accountability, and limits on services in Medicaid. It would also allow co-pays or cost sharing that apply to all Medicaid eligible groups – not just optional Medicaid populations – and tailor benefits to needs of the individual rather than a blanket entitlement.

Gov. Perry has consistently rejected federal funding when strings are attached that impose long-term financial burdens on Texans, or cede state control of state issues to the federal government. In 2009, Texas rejected Washington funding for the state’s Unemployment Insurance program because it would have required the state to vastly expand the number of workers entitled to draw unemployment benefits, leading to higher UI taxes later.”

Florida

In an editorial to the Washington Times Florida Governor Rick Scott writes:

“I think everyone agrees there are far too many who want health insurance and can’t get it. But the truth is, the real problem isn’t with health insurance. The underlying cause is the rapidly increasing cost of health care.

After the U.S. Supreme Court’s stunning pronouncement on Obamacare, all 50 governors face two big decisions:

1. Do we let the federal government impose a massive Medicaid expansion on us?
2. Do we establish a state insurance exchange or let the federal government come in and run it?

My answer is simple. No. We just can’t afford it.

Medicaid is the fastest-growing part of our state budget. And unlike the federal government, which isn’t required to balance its budget, we could only pay for expanding Medicaid by increasing taxes or cutting from other parts of the budget. Expanding Medicaid puts other vital government functions, such as education, public safety and infrastructure, at risk. That is not something I am willing to do.”

Wisconsin

Governor Scott Walker released a statement last week, “Wisconsin will not take any action to implement ObamaCare I am hopeful that political changes in Washington D.C. later this year ultimately end the implementation of this law at the federal level.”

Walker indicated over the weekend that he will wait until after the November election before announcing whether Wisconsin will participate in the health care exchange program. Walker has shown no signs that he is interested in implementing the Affordable Care Act and has returned a grant from the federal government intended to help get the exchanges off the ground.

Louisiana & Virginia

“We’re not going to start implementing Obamacare,” Jindal said during a conference call with Virginia Gov. Bob McDonnell. “We’re committed to working to elect Governor Romney to repeal Obamacare.”

“Here in Louisiana we have not applied for the grants, we have not accepted many of these dollars, we’re not implementing the exchanges. We don’t think it makes any sense to implement Obamacare in Louisiana. We’re going to do what we can to fight it.”

On the same conference call on Friday, McDonnell, said he would evaluate the options for Virginia. “We don’t even know exactly what that federal exchange would look like so there’s still some uncertainty at this point as to what the right course is, and in the next days and weeks we’re going to be evaluating the case as well as the options for Virginia,” McDonnell said.

Maine

Gov. Paul LePage used his weekly radio address Saturday to further his long-running criticisms of the federal Affordable Care Act and explain why he is delaying its implementation in Maine.

LePage said his administration would resist implementing the Affordable Care Act, particularly an expansion of Medicaid, because of debt Maine already has on the books — including $500 million due to the state’s hospitals — and what he characterized as a welfare program that is already too generous.

“Our welfare costs are among the highest in the nation as a result of some of the lowest eligibility requirements. Maine has increased its spending by more than a billion dollars during the last decade because of expanded welfare programs,” said LePage “We cannot afford our current programs, so to require Maine to expand coverage even more is fiscally irresponsible.”

Illinois

Gov. Pat Quinn signed into law HB5007, which allows the Cook County Health and Hospitals System to immediately increase Medicaid eligibility for 100,000 county patients and pay for it through increased federal funding. The money will allow the counties to continue treating needy people  who have not been on the Medicaid roles but now to be reimbursed through a direct federal waiver.

Oklahoma

“In light of the Supreme Court’s decision to uphold most of the (act), Governor Fallin believes it is her responsibility to thoroughly and thoughtfully review the state of Oklahoma’s options regarding the future of both Medicaid and the creation of a health insurance exchange,” Fallin spokesman Alex Weintz said. “Her priority is not to make a decision soon; it is to make the right decision. The governor will continue to review how the state of Oklahoma can best meet the health care needs of its citizens.”

It appears many states’ budgets will dictate their actions and many will wait until the November election before making any further commitments.

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