Republican governors aren't the only state executives taking a long, hard look at their options now that the Supreme Court has given them the freedom to opt out of ObamaCare's Medicaid expansion without risking existing federal funds. Democrats running states across the country are wary too. Via The Washington Post:
While the resistance of Republican governors has dominated the debate over the health-care law following last month's Supreme Court decision to uphold it, a number of Democratic governors are also quietly voicing concerns about a key provision to expand coverage.
At least seven Democratic governors have been noncommittal about their willingness to go along with expanding their states' Medicaid programs, the chief means by which the law would extend coverage to millions of Americans with incomes below or near the poverty line.
"Unlike the federal government, Montana can't just print money," Gov. Brian Schweitzer (D) said in a statement Wednesday. "We have a budget surplus, and we're going to keep it that way."
The law would add an estimated 84,000 people to Montana's Medicaid program, doubling its size, the governor said. Although the federal government would pay the vast majority of the additional costs, Montana's health department estimates the state's share would reach $71 million in 2019.
Part of the problem is that the high court's ruling left a lot of operational questions unanswered, especially about how the program will operate down the line. And so far the Obama administration hasn't exactly been forthcoming with helpful details:
At least one governor, Democrat Mike Beebe of Arkansas, has also tried contacting the Obama administration directly.
According to spokesman Matt DeCample, Beebe is "leaning toward" the Medicaid expansion, which he said would add between 200,000 and 250,000 Arkansans to the Medicaid rolls in a state whose population is around 3 million. Not only would it bring a significant injection of federal funds to the state, but it would also be a boon to Arkansas hospitals, which are currently treating many poor people for free.
But DeCample said the governor has concerns that there be "state flexibility down the line." So last week, Beebe asked officials at the federal Centers for Medicare and Medicaid Services whether, in the event of an unforeseen future fiscal calamity, Arkansas would be able to tighten its eligibility rules and still get the full federal match for those who continued to qualify for its Medicaid program.
To date, Beebe has received no answer.
Obviously there's a signficant political component to the GOP's resistance to the Medicaid expansion. But the wariness of Democratic governors suggests that it's not entirely about team red vs team blue chest thumping. There are important fiscal and administrative issues at stake too. Nor is this new. After Tennessee dramatically expanded its Medicaid program in the mid 1990s, the program quickly threatened to chew up most of the state's budget. And it was a Democrat, Gov. Phil Bredesen, who decided to massively scale back the program rather than risk letting it bankrupt the state.