Virginia Gov. Bob McDonnell told members of the General Assembly on Tuesday that it is too early to say whether the state will follow the lead of a handful of Republican governors who have vowed not to implement key portions of President Obama's health care overhaul.
Mr. McDonnell wrote to state legislators that his staff and the Department of Medical Assistance Services are still evaluating the law's provision that expands states' Medicaid rolls. The U.S. Supreme Court upheld the law as constitutional but said the federal government could not withhold current Medicaid funding if states decline to participate in the expansion.
Mr. McDonnell, chairman of the Republican Governors Association, wrote a separate letter to Mr. Obama on behalf of fellow GOP governors, noting that if states opt out of the Medicaid expansion, there likely will be a significant gap in coverage for low-income people who don't qualify for tax credits.
He also questioned how the government could afford to even implement the law "with deficits already over $1 trillion in every year of your presidency, and the debt growing $5 trillion in the past 3 years to an outrageous record of nearly $16 trillion."
"The consequences of governors' decisions will impact our states — and the nation — for decades to come, so we must have all the information needed to choose wisely," he wrote.
Through 2016, the federal government would subsidize all of the costs for newly eligible Medicaid recipients and wind down to a 90 percent match by 2020 — still a higher rate than the 50-50 match the state has now. State officials have estimated that the law could result in 425,000 new enrollees.
Mr. McDonnell characterized the growth of Medicaid in the state's budget as "an unsustainable trajectory that demands improvement and greater efficiency." Medicaid spending has grown 1,600 percent over the past three decades, and the program now comprises about one-fifth of the state budget.
A 2010 estimate showed that the Medicaid expansion would cost Virginia $2.2 billion starting in 2014, but Mr. McDonnell wrote that the Department of Medical Assistance Services is currently updating that projection.
As part of the health care law, states must also set up and operate health benefit exchanges where people can shop for and purchase insurance, or the federal government will step in and set one up for them.
Several legislators introduced bills this year to set up an exchange within the state, but they were not taken up.
Mr. McDonnell wrote Tuesday that there are too many "uncertainties and variables" to make an informed decision on the exchange question — namely a lack of detail on what a federal exchange would look like and the extension of an application deadline for exchange grant money from the federal government.
He also alluded to Mitt Romney's pledge to act to repeal the entire law and grant waivers to the states if he defeats Mr. Obama in November.
"Thus, with multiple unanswered questions and great uncertainty, it is not prudent to spend a great deal of time and taxpayer money on building a system that we may never need to implement or that may be materially different once the rules are finally established," he wrote.
At this point, Mr. McDonnell does not plan to call a special session of the legislature to deal with the exchange question.
"I remain convinced for now that a special session would not be a good use of taxpayer dollars," he wrote. "I am committed to doing what is best for Virginians, and to comply with the law in the least intrusive and bureaucratic way."
Mr. McDonnell's office also released a partial list of questions sent to the Department of Health and Human Services regarding the exchanges and the Medicaid expansion.
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