With the Supreme Court no longer threatening the future of the Affordable Care Act, and with implementation deadlines looming, Republican governors have some decisions to make. They oppose the federal law, despite the benefits it'll bring to their state and constituents, but ignoring it brings a host of other problems.
Some, including Michigan Gov. Rick Snyder (R), are prepared to move forward, implementing the law and creating exchanges for consumers. New Mexico Gov. Susana Martinez (R) has also suggested she supports some of the provisions in "Obamacare."
On the other hand, we also see governors like Rick Scott (R) of Florida, whose office announced that it will simply refuse to move forward under the current framework. "We are not going to expand Medicaid and we're not going to implement exchanges,'' Scott's spokesperson told the AP. The governor's office also said Medicaid expansion would cost Florida taxpayers $1.9 billion a year -- an imaginary figure that Rick Scott appears to have made up out of whole cloth.
Steve Kornacki has a good piece today on the bigger picture.
[T]here's an element of posturing here. The question is how many GOP governors and state legislatures will ultimately relent and take the federal money.Logic says that most, if not all, of them will. After all, the federal government is offering a pretty good deal to the states, and some powerful interests -- hospitals that now end up providing free emergency care for patients who would be eligible for Medicaid under the expansion and insurance companies offering Medicaid managed care plans -- figure to exert considerable pressure on state leaders to go along. Particularly for a governor like [New Jersey's Chris Christie], who leads a blue state and is facing reelection in 2013, it might not take much pressure to convince him to implement the expansion.
I think that's right, on all counts. Obamacare offers the states a pretty sweet deal, which the governors would be foolish to turn down. If they balk anyway, every hospital administrator in their state will be calling the governor's office, demanding that these Republican cut the nonsense.
I'm just not convinced the truly unhinged governors will care.
Last year, logic dictated that Rick Scott and Scott Walker would take federal funds for high-speed rail, too. Time and again, some GOP governors have made it clear that partisan and ideological goals trump literally every other consideration -- including their constituents' wellbeing.
And what happens if some Republican chief executives simply balk? First and foremost, millions of struggling Americans simply won't get the coverage and access to basic care they would otherwise get if they had more responsible governors. The ACA brings insurance to 30 million people, but that number will drop if Rick Scott and officials like him refuse to implement federal law.
Second, as we discussed last week, these governors are also, rather ironically, inviting more federal control over state affairs.
And finally, it's not inconceivable that we'll face another round of lawsuits if states like Florida pretend the federal law doesn't exist, and refuse to honor its provisions.
Kornacki added, however, that political conditions may yet change: "Pressure from Republican-friendly healthcare industry forces might make it more palatable to the right, and if GOP leaders in individual states present a united front in support of the expansion, the base would be more likely to go along and not consider it a big deal. But as long as Obama is president and his name is linked to it, there's always going to be some kind of an opening for a Republican politician to make a name for himself by vowing to stop or reverse the expansion."