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| FILE - In this May 16, 2012 file photo, Florida Gov. Rick Scott speaks in Fort Lauderdale. Florida Gov. Rick Scott, long opposed President Barack Obama's remake of the health insurance market. After President Obama won re-election, the Republican governor softened his tone. He said he wanted to "have a conversation" with the administration about implementing the 2010 law. |
ATLANTA (AP) -- Florida Gov. Rick Scott, who made a fortune as a health care executive, long opposed President Barack Obama's remake of the health insurance market. After the Democratic president won re-election, the Republican governor softened his tone. He said he wanted to "have a conversation" with the administration about implementing the 2010 law. With a federal deadline approaching, he also said while
Florida won't set up the exchange for individuals to buy private insurance policies, the feds can do it.
In New Jersey, Gov. Chris
Christie held his cards before saying he won't set up his own exchange,
but he's avoided absolute language and says he could change his mind.
He's also leaving his options open to accept federal money to expand
Medicaid insurance for people who aren't covered. The caveat, Christie
says, is whether Health Secretary Kathleen Sebelius can "answer my
questions" about its operations and expense.
Both
Republican governors face re-election in states that Obama won twice,
Christie in 2013 and Scott in 2014. And both will encounter
well-financed Democrats.
Their apparent
struggles on the issue, along with other postures by their GOP
colleagues elsewhere, suggest political uncertainty for Republicans as
the Affordable Care Act starts to go into effect two years after
clearing Congress without a single Republican vote. The risks also are
acute for governors in Democratic-leaning or swing-voting states or who
know their records will be parsed should they seek the presidency in
2016 or beyond.
"It's a tough call for many
Republican governors who want to do the best thing for their state but
don't want to be seen as advancing an overhaul that many Republicans
continue to detest," said Whit Ayers, a consultant in Virginia whose
clients include Gov. Bill Haslam of Tennessee, a Republican who didn't
announce his rejection of a state exchange until days before Sebelius's
Dec. 14 deadline.
Indeed, cracks keep growing
in the near-unanimous Republican rejection of Obama's health care law
that characterized the GOP's political messaging for the last two years.
Five GOP-led states - Idaho, Mississippi, Nevada, New Mexico, and Utah -
are pressing ahead with state insurance exchanges. Ongoing monitoring
by The Associated Press shows that another five Republican-led states
are pursuing or seriously a partnership with Washington to help run the
new markets.
Democrats, meanwhile, hope to use
the law and Republican inflexibility to their advantage, betting that
more Americans will embrace the law once it expands coverage. The
calculus for voters, Democrats assume, will become more about the policy
and less about a polarizing president.
"It
shouldn't be complicated at all," said John Anzalone, an Obama pollster
who assists Democrats in federal races across the country. Anzalone said
Republicans could use their own states-rights argument to justify
running exchanges. Instead, he said, "They are blinded by Obama-hatred
rather than seeing what's good for their citizens."
Governors
can set up their own exchanges, partner with Sebelius' agency or let
the federal government do it. The exchanges are set to open Jan. 1,
2014, allowing individuals and businesses to shop online for individual
policies from private insurers. Low- and middle-income individuals will
get federal premium subsidies calculated on a sliding income scale.
Eighteen states plus Washington, DC, most led by Democrats, have
committed to opening their own exchanges.
The
law also calls for raising the income threshold for Medicaid eligibility
to cover people making up to 138 percent of the federal poverty line,
or about $15,400 a year for an individual. That could add more than 10
million people, most of them childless adults, to the joint
state-federal insurance program for low-income and disabled Americans.
Together, the exchanges and the Medicaid expansion are expected to
reduce the number of uninsured by about 30 million people within the
next decade.
A Supreme Court ruling last
summer made the Medicaid expansion voluntary, rather than mandatory for
states. At least eight governors, all of them Republicans, have already
said they have no plans to expand Medicaid.
The complexity is obvious.
National
exit polls from last month's election showed that 49 percent of voters
wanted some or all of Obama's signature legislative achievement rolled
back. Among self-identified independents, that number was 58 percent.
Among Republicans, it spiked to 81 percent. When asked about the role of
government, half of respondents said the notion that government is
doing too much fits their views more closely than the idea that
government should do more.
Before the
election, a national AP-GfK poll suggested that 63 percent of
respondents preferred their states to run insurance exchanges, almost
double the 32 percent who wanted the federal government to take that
role. And the same electorate that tilts toward repealing some or all of
the new law clearly re-elected its champion.
That's
not the most important consideration for governors who face re-election
in Republican states. Georgia's Nathan Deal and Alabama's Robert
Bentley, who also face 2014 campaigns, initially set up advisory
commissions to consider how to carry out the health care law, but
they've since jumped ship. But, unlike others, Deal and Bentley aren't
eyeing national office.
Three Republicans who
are viewed as potential national candidates - Rick Perry of Texas, Nikki
Haley of South Carolina and Bobby Jindal of Louisiana - were
full-throated opponents. Jindal, the only one of the three who is
term-limited, is the incoming chairman of the Republican Governors
Association. In that role, he has co-signed more conciliatory letters to
Sebelius asking questions to flesh out how the designs might work.
Republican governors also are feeling quiet pressure from hospitals and other providers.
Deal,
the Georgia governor, offers the typical argument for saying no: "We
can't afford it." But the law envisions the new Medicaid coverage more
or less as a replacement of an existing financing situation that pays
hospitals to treat the uninsured. The law contemplates cuts in that
program, which already requires state seed money. The idea was that
expanding Medicaid coverage would reduce "uncompensated care" costs.
"Some
of those cuts were made with the expectation that Medicaid would be
expanded and that hospitals would be paid for portions of business that
we are not being paid for now," said Don Dalton of the North Carolina
Hospital Association.
Dalton's Governor-elect,
Republican Pat McCrory, said as a candidate that he opposed Medicaid
expansion. Dalton said his industry is leaning on McCrory and
legislative leaders, though he commended "their deliberate approach."
Similar efforts are underway in South Carolina, Georgia, Missouri and
elsewhere.
For Democrats, Anzalone said the
framing will be simpler: "You don't want to take a 9-to-1 match? That's a
pretty easy investment. These governors who aren't expanding Medicaid,
they're basically giving taxpayer money to the states that do."
