Time is running out for states to decide whether they will expand their Medicaid programs under President Obama's health law — a decision that pits governors who think it is too good of a deal to pass up against conservative lawmakers who see it as a budget-busting gamble.
As statehouses wind down their legislative business for the year, governors in 28 states support an extension of the federal-state program for the poor under the Affordable Care Act, with 20 opposing it, and leaders in Kansas and South Dakota are still weighing their options, according to the nonpartisan Kaiser Family Foundation.
But some states are seeing major battles between their governors and legislatures and could have to hold special sessions to work things out.
Those include Florida, where Republican Gov. Rick Scott's bold support for Medicaid expansion hit a wall of legislative opposition, and Mississippi, where an odd set of circumstances could put the entire Medicaid program at risk
Extending Medicaid benefits to those making up to 138 percent of the poverty level is a key pillar of the health care law.
The federal government will pay for 100 percent of the expanded population through 2016 before scaling down its contribution to 90 percent in 2020 and beyond.
There is no deadline for a state to decide whether to expand its Medicaid population, so firm decisions made in the states this year are in anticipation of January 2014 — when state-based expansions under Mr. Obama's law debut. But a decision now would not prevent a state from reconsidering in the future, said Robin Rudowitz, associate director for the Kaiser Commission on Medicaid and the Uninsured.
For many state leaders, the political calculus is a dicey one. Skeptical Republican lawmakers say the entitlement program already cuts a wide swath from their budgets and the federal government might default on its promise to pick up the lion's share of the expansion's costs.
Kansas Gov. Sam Brownback is among those concerned about Washington's long-term commitment, but he is working with the lawmakers to find a "financially sustainable" solution to the Medicaid question, his spokeswoman said.
In Texas, Gov. Rick Perry has said he will not entertain any moves tied to "Obamacare."
But fellow conservative stalwarts, including Mr. Scott, Arizona Gov. Jan Brewer and Ohio Gov. John Kasich, have argued an expansion is the right thing to do, morally and economically, placing them at odds with some right-leaning politicians in their states.
"Gov. Brewer is committed to her Medicaid plan, and has indicated she will not sign a budget that does not address this issue," her spokesman Matthew Benson said.
Led by Arkansas, some states want to use the federal funds to buy private insurance for their qualifying residents. Other states, including Virginia, put off talk of expanding Medicaid until a commission studies and proposes reforms.
The two-phase nature of the process, in which governors declare their intentions and wait for the legislature to sign off on them, makes it difficult to figure out when a state has arrived at a firm decision.
"It's been pretty hard to pinpoint, particularly on the 'no' states," Ms. Rudowitz said.
Mississippi Gov. Phil Bryant, a Republican, is in a standoff with the legislature in Jackson, where Democrats blocked efforts to appropriate funds for the state's Medicaid program — an attempt to gain leverage in the fight over expansion.
Mr. Bryant lambasted Democrats last month for "playing a political game with the lives of the 641,194 children, pregnant women, and aged, blind, and disabled adults currently receiving medical services through Medicaid."
Since then, Mr. Bryant has suggested he will try to run the state's Medicaid programs through is executive powers if the issue is not resolved within the legislature.
"He has repeatedly stated that when Democrats are ready to fund and reauthorize the current Medicaid program, he will call a special session so Mississippi can continue providing services to children, pregnant women and aged, blind and disabled adults," Bryant spokesman Mick Bullock said Monday.
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