As states near a critical decision regarding Obamacare by Friday, many GOP governors once opposed to the healthcare law are gradually accepting House Speaker John Boehner’s declaration that Obamacare is now “the law of the land.”
“The election is over and President Obama won,” one of Obamacare’s strongest opponents, Florida Gov. Rick Scott, said earlier this week in dropping his opposition to the law.
“I’m responsible for the families of Florida,” Scott said, whose state has nearly 4 million uninsured people. “If I can get to ‘yes,’ I want to get to ‘yes.’ ”
Obamacare, which was upheld in June by the U.S. Supreme Court, requires states to decide by Friday whether they will establish health insurance exchanges.
These Internet marketplaces give individuals the opportunity to compare and purchase private health insurance or, if eligible, enroll in public Medicaid coverage.
Small businesses may use the exchanges to offer their employees a choice of coverage at group rates under the Small Business Health Options Program.
States interested in operating their own exchanges without federal involvement must notify the Department of Health and Human Services by Friday, but they get until Dec. 14 to provide the details.
Federal tax credits tied to income will help many shoppers pay for coverage on the exchange. And competition among insurers and a large number of customers are expected to keep premiums low. Enrollment on the exchanges begins next October, with coverage taking effect in January 2014.
Obamacare requires all Americans to have health insurance in 2014 or pay a fine.
More than 9 million people are expected to get coverage through the exchanges in 2014, and 25 million in 2017, according to estimates by Avalere Health, a Washington healthcare consulting firm.
A number of Republican states , Florida among them, put off establishing the exchanges, hoping that Republican Mitt Romney would win the White House on Election Day.
But President Barack Obama was re-elected – and that dashed the hopes of many GOP governors and other state officials on seeing Obamacare repealed.
“It's a very practical decision for states now," said Alan Weil, executive director of the nonpartisan National Academy for State Health Policy in Washington. "We are going to have a significant number of states running their own exchanges, a significant number where the federal government is running the exchange, and a significant number of partnerships.
“The bottom line is we are going to have to figure out how to make all three models work," Weil said.
In Mississippi, GOP Insurance Commissioner Mike Chaney notified Washington on Wednesday that his agency will proceed with a state-run exchange. The move, however, disappointed GOP Gov. Phil Bryant, who still strongly opposes Obamacare.
"If you default to the federal government, you forever give the keys to the state's health insurance market to the federal government,” Chaney said.
And as for trying to battle the federal government, Chaney added: “We tried that 150 years ago in the South, and it doesn't work.”
In New Mexico, Republican Gov. Susana Martinez’s administration had been working to put the law into place. With a fifth of its population uninsured, the state plans to operate its own exchange.
“The party is over. The opposition is over," New Mexico Human Services Secretary Sidonie Squier said. "Whatever states didn't think they were going to do it, I think they're going to have to do it whether they like it or not. It's a done deal now."
Ohio, like Florida, is leaning toward a partnership with the federal government.
In Iowa, GOP Gov. Terry Branstad is postponing a decision pending more information from Washington.
But his spokesman, Tim Albrecht, said Iowa is exploring a partnership exchange that could include several states. Albrecht said they believe they can get to a state option if needed.
Branstad also said he was leaning against expanding Medicaid.
“We don’t want to get trapped in something we can’t afford and can’t be sustained,” he said.
In Virginia, Gov. Robert McDonnell also echoed Branstad’s concerns, saying he was hesitant to expand Medicaid unless the states are given more power to run the program.
“There are too many unanswered questions to make the decisions,” McDonnell said at a meeting of the Republican Governors Association on Thursday in Las Vegas.
But many other governors are still balking, citing excessive costs and regulation.
“It’s a bad piece of legislation,” Louisiana GOP Gov. Bobby Jindal said at the governors’ meeting. “It’s going to have a lot of unintended consequences.”
The governors sent a letter to the Obama administration, asking for more time.
Other GOP states also are holding fast.
In Texas, the election results did not change any of the opposition to expanding Medicaid or to setting up insurance exchanges. Likewise for South Carolina, Missouri, Kansas, and several others.
“Adding more people to an already sinking ship with money that is either being borrowed from China or coming out of taxpayers' pockets is bad policy and bad for Texans," said Catherine Frazier, spokeswoman for Texas Gov. Rick Perry.
Twenty-seven percent of Texas residents are uninsured, the largest percentage for any state.
Maine Gov. Paul LePage is not setting up a state exchange where residents who don’t receive health insurance through their employers can shop for subsidized plans.
“I’m not lifting a finger,” he said. “We’re not going to get involved. We’re going to let Mr. Obama do a federal exchange. It’s his bill.”
Georgia Gov. Nathan Deal said, “I don’t see how we can afford it.”
At the Las Vegas meeting, governors that included Jan Brewer of Arizona and Mary Fallin of Oklahoma said they were still weighing their options on Medicaid expansion.
Wisconsin Gov. Scott Walker said he’ll announce his plans by the Friday deadline.
“It’s the law and we’ll comply with the law,” Walker said at the meeting. “The question is which way do we go about doing that.”
The Associated Press, Bloomberg News, and McClatchy Newspapers contributed to this report.
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