Rebellion in states to block broader Medicaid; governors face party opposition

Many Republican governors who said they plan to take Medicaid money under President Obama’s health care law now find they’re facing a revolt within their own state parties, where GOP legislatures are none-too-eager to approve signing up for what they call “Obamacare.”

In Arizona, Gov. Jan Brewer held a rally with doctors and nurses on Tuesday to try to build support ahead of a showdown with the Republican-dominated Legislature.

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“I don’t think there’s any question this is an uphill fight,” said her spokesman, Matt Benson. “The governor is all-in. She is fully committed to this effort.”

In Florida, meanwhile, a legislative panel rejected Gov. Rick Scott’s surprising decision to expand Medicaid, leaving his plan wounded.

“I don’t think it’s dead in the water yet, but it’s on life support,” said Susan MacManus, a political science professor at the University of South Florida.

But in embracing an expansion of the federal-state health program for the poor and disabled, Mr. Scott is in the awkward position of taking a more liberal stance than some Republican legislators on health reforms he once lambasted.

Republican governors have wrestled with the economics and politics since the Supreme Court ruled last year that states could choose to accept or reject expansion of Medicaid in the Affordable Care Act,

Those who have accepted an expansion say the federal funds are too important to pass up, while those who have rejected the money say they fear the strings attached and the long-term costs.

Eight Republican governors have supported the expansion, and many are wrestling with wary legislatures.

While there is no deadline for states to accept or decline Medicaid expansion, states are rejecting vast federal resources with every budget season that goes by, said I. Glenn Cohen, a health policy expert at Harvard Law School.

“In these economic times, including in the shadow of the sequester’s effect on state budgeting, it will be hard to leave money on the table even temporarily,” he said.

Under Mr. Obama’s reforms, states can opt to expand the health entitlement to those earning up to 138 percent of the federal poverty level. The federal government will pay for 100 percent of the expansion in 2014-2016 before scaling back its contribution to 90 percent.

Mr. Scott wants to expand Medicaid for the three years in which the feds will pick up the full tab. The expansion would then sunset if it the economics turn sour, he said.

About 750 miles north, Virginia Gov. Bob McDonnell’s problem is one of messaging as he disputes claims he agreed to expand Medicaid as a trade-off for passage of his comprehensive transportation bill.

In a recent letter to Health and Human Services Secretary Kathleen Sebelius, he said any suggestions by Virginia lawmakers and media outlets that he agreed to expand Medicaid are “absolutely incorrect” and that he must make drastic changes before he’ll sign Virginia up for expansion.

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