Iowa on Monday became the latest state to suggest it will refuse to expand its Medicaid program under President Obama’s health care law once the option becomes available in 2014.
Gov. Terry Branstad, a Republican, announced at a Des Moines news conference that while his staff is still assessing the Supreme Court ruling on the Affordable Care Act (ACA), he expects to forgo the federal funding that would allow an estimated 150,000 low-income Iowans to enroll in the state Medicaid program.
Although Thursday’s Supreme Court decision upheld the bulk of the law, it also provided state leaders with an opportunity to refuse Medicaid expansion by striking down the clause that allowed the federal government to withhold all Medicaid funds from a state if it did not expand the program.
Since then, Republican governors from Wisconsin, Louisiana, Florida and South Carolina have declared they will not participate in the expansion, while the governors of Missouri, South Dakota and Alabama have said they might not. Missouri’s governor is a Democrat; the others are both Republicans.
“State after state is going to say no,” Mr. Branstad said Monday. “It appears this federal blackmail to the states is not going to be permitted — I think that’s good.”
Yet state governors run the risk of angering low-income voters who stand to benefit from a Medicaid expansion, especially since the law’s controversial “individual mandate,” which the court upheld, will require them to obtain health insurance elsewhere. Nine of the 10 states with the highest rates of uninsured residents have Republican governors who have spoken out against the ACA.
According to a Gallup survey, roughly 27 percent of Texans live without health insurance, giving the state the highest rate of uninsured residents in the country. With more than 7 million uninsured, the state has remained at the center of the health care debate.
Gov. Rick Perry — a former Republican presidential candidate and one of the most outspoken critics of the ACA since it was passed two years ago — denounced the Supreme Court ruling last week and called for the law’s repeal after the 2012 election. Mr. Perry has consistently advocated for free- market solutions to health care and fought what he describes as the ballooning costs of Medicaid and Medicare.
“Obamacare is bad for the economy, bad for health care, bad for freedom,” Mr. Perry said on Thursday. “We citizens must take action at every level of government and demand real reform.”
Texas officials have yet to decide on the “opt out clause,” but Mr. Perry has thus far refused to implement a health-care exchange, another provision of the ACA that aims to build a competitive marketplace in the state for insurance coverage.
Not all states are coming together to oppose the law, however. California, which has roughly 8 million uninsured residents, celebrated the decision as a critical step in meeting the needs of low-income residents.
“[The] Supreme Court ruling removes the last roadblock to fulfilling President Obama’s historic plan to bring health care to millions,” California Gov. Jerry Brown, a Democrat, said Thursday.
Since the ACA was passed, California has taken several measures to speed up its implementation; it was the first state to set up a health-care exchange through a federally run program online.
The state aims to provide insurance for as many as 3 million through the Medicaid expansion, and hopes to combat its 22 percent uninsured rate, which has grown by close to 1 percentage point since it began taking steps to prepare for the ACA.