The Obama administration's all-out public relations push to sell its health care reform law increasingly is targeting individual governors, who will bear much of the blame, the White House says, if millions of poor Americans remain uninsured.
Administration officials Monday joined with state and local Democratic leaders in North Carolina to put pressure on Gov. Pat McCrory, a Republican, to expand Medicaid eligibility under Obamacare.
Under Mr. McCrory, North Carolina is one of two dozen states that so far have opted out of that expansion, a crucial building block of the Affordable Care Act but one that became voluntary as a result of a Supreme Court decision last year.
"The only explanation is political," said White House principal deputy press secretary Josh Earnest, speaking of Mr. McCrory's and other governors' reluctance to expand Medicaid. Mr. Earnest was joined by Durham, N.C., Mayor Bill Bell and state Sen. Floyd McKissick, both Democrats, on a Monday afternoon conference call.
North Carolina is just the latest state to come under direct fire from a White House that admittedly is waging a full-blown PR offensive in response to Obamacare's rocky rollout.
Administration officials also have held conference calls aimed at Louisiana, South Carolina, Pennsylvania, Florida and other Republican-led states that haven't made Medicaid available to more people in their states.
President Obama himself has thrown a few punches in the fight, using a recent Democratic Party fundraiser in Texas to blast that state's governor, Republican Rick Perry, for resisting expanded Medicaid.
Such a decision will carry grave consequences for Texas, North Carolina or any other state, the White House argues.
"That is a disservice to the citizens in these states that could have access to quality, affordable health insurance, many for the very first time," Mr. Earnest said, after noting that 1.2 million Texans, 377,000 North Carolina residents and a total of 5.4 million people across the country could receive Medicaid coverage if governors dropped their opposition.
Mr. McCrory's office didn't respond to requests for comment Monday, but he and other critics of the health care reform law and its Medicaid expansion provision have cited the program's cost overruns and other problems as reasons to opt out.
"I will not sacrifice quality care for the people truly in need nor risk further budget overruns by expanding an already broken system," Mr. McCrory said in an October statement, adding that Medicaid must be reformed, not expanded.
Critics also have pointed to the eventual increase in costs to individual states.
Under Obamacare, the federal government would pick up the tab for all Medicaid expansion for the first three years; that figure drops to 90 percent in year four, leaving states on the hook for the rest of the bill.
Whether it be future costs or other factors, state resistance to Medicaid expansion could undermine the law.
The larger health care reform effort — which has been plagued by problems since much of it went into effect Oct. 1 — hinges on getting coverage to as many Americans as possible. To that end, analysts say the administration's public-relations push is designed to get local and state officials, and the people they represent, to support Medicaid expansion and demand their governor participate.
"There is a tremendous gap in the law ... When Congress passed the law, it assumed Medicaid for the poorest people," said Sara Rosenbaum, chairwoman of the Department of Health Policy at George Washington University. "The bottom line on the whole is that if you don't expand Medicaid, people are going to be without coverage."
Mr. McKissick, who represents parts of North Carolina's Durham and Granville counties, echoed those thoughts on Monday's conference call.
"It was assumed Medicaid would be expanded," he said, adding that rural hospitals in his district and across the state will continue to shoulder the cost of the uninsured flocking to emergency rooms and sticking taxpayers with the tab.
While the debate over Medicaid expansion has broken down largely along party lines, there are exceptions.
The White House frequently points to Republican governors such as Arizona's Jan Brewer and Ohio's John Kasich who have embraced the idea and allowed it to move forward in their states, despite strong opposition to Obamacare as a whole.
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