WASHINGTON: From the South to the heartland, cracks are appearing in the once-solid wall of Republican resistance to President Barack Obama’s health-care law.
Ahead of an expected federal deadline today for states to declare their intentions, governors and state officials interviewed around the country expressed surprising openness to the changes in some cases. Opposition persists in others, and there is a widespread, urgent desire for answers on key unresolved details.
Late Thursday, the Obama administration bowed to Republican governors’ request for more time to decide, pushing the deadline back to Dec. 14. Many states are still expected to announce their choices today, but a check by the Associated Press found that 16 states are still mulling over their decisions.
The law that Republicans have derided as “Obamacare” was devised in Washington, but it’s in the states that Americans will find out if it works, delivering promised coverage to more than 30 million uninsured people.
States are being asked to declare if they’ll build new online insurance markets for individuals and small businesses to shop for subsidized private coverage — or let Washington do it for them. States can also opt for a partnership with the feds to run these markets, known as exchanges, and they have until February to decide on that option.
Ohio Gov. John Kasich, who was at the Republican Governors Association conference Thursday in Las Vegas, has hinted that he will forgo the opportunity to establish and operate a state-based exchange.
Kasich’s staff already has drafted a letter it will send today to the Obama administration, and aides to Kasich told the Columbus Dispatch not to expect surprises in the letter.
During two days of meetings, Kasich and colleagues who have fought Obama’s health-care initiative each step of the way acknowledged that the president’s re-election last week cemented Obamacare as law. The governors pledged to work with the White House where possible.
Florida was a leader in the failed effort to overturn the health-care law in the Supreme Court, and a group formed by Republican Gov. Rick Scott ran TV ads opposing it before it passed Congress. But the governor told the AP this week he wants to negotiate with the federal government to try to help the nearly 4 million uninsured people in his state.
“If I can get to ‘yes,’ I want to get to ‘yes,’ ” Scott said.
In Iowa, GOP Gov. Terry Branstad said he is postponing a decision because Washington has not provided enough information about key details.
In Mississippi, Republican insurance commissioner Mike Chaney formally notified Washington on Wednesday that his agency will proceed with a state-run exchange, disappointing GOP Gov. Phil Bryant, who remains staunchly opposed to Obama’s law.
In New Mexico, Republican Gov. Susana Martinez quietly worked to put the law into place as the political storm swirled. With a fifth of its population uninsured, the state is planning to run 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.”
A look at advantages
There are several potential benefits to a state operating its own exchange, experts say.
The biggest advantage may be that states would be more closely involved in coordinating between the exchanges and Medicaid programs. Because many people are going to be going back and forth between Medicaid and private coverage in the exchanges, states would probably be better served by a hands-on role.
States can also decide whether to allow open access to all insurers, or work only with a panel of pre-screened companies that meet certain criteria.
Despite signs of movement toward going along with implementation of the overhaul, some major Republican-led states are holding fast. In Texas, the election results did not change any of the opposition to expanding Medicaid or to setting up insurance exchanges. The same holds for Louisiana, South Carolina, Missouri, Kansas and others.
Virginia, a Republican-led state that voted for Obama on Nov. 6 and also elected a Democratic U.S. senator, is among those defaulting to Washington. But a spokesman for Gov. Bob McDonnell said things may change.
“This is not a final decision,” said Jeff Caldwell. “The fact is, states still need far more information before any final decisions can be made on behalf of Virginia’s taxpayers.”
The Columbus Dispatch contributed to this report.