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As deadlines loom, Florida changes its tune on the ACA

Post-election, governors nationwide weigh Medicaid expansion choices

Topics: Health Policy, Market Trends, Strategy, Medicaid, Reimbursement, Finance

November 14, 2012

With major Affordable Care Act (ACA) deadlines looming just two weeks after the presidential election, Florida Gov. Rick Scott (R) has dropped his opposition to the law, a move that could open up discussions for Medicaid expansion in the Sunshine State.

According to Politico, states must soon declare their positions on two key ACA: the expansion of Medicaid and the creation of state health insurance exchanges. Many governors said they would announce their decisions based on the outcome of the election, which would determine the fate of the ACA.

Medicaid expansion

This week, the governors of Alabama, Florida, and South Dakota publicly stated new positions on the Medicaid expansion.

  • Alabama: Gov. Robert Bentley (R) on Tuesday announced that his state will not participate in the Medicaid expansion. Bentley added that he will not expand the program "under the current structure that exists" because Alabama "simply cannot afford it. Meanwhile, a spokesperson for Bentley said the governor has "serious concerns" about the cost and still is "evaluating the issues."
  • Florida: Gov. Rick Scott (R) on Tuesday told the Associated Press that he is willing to negotiate with the Obama administration on the ACA's provisions. In July, Scott was one of three Republican governors who issued statements or made public comments confirming that they will not expand Medicaid in their states and instead will assist efforts to repeal the law. However, Scott did not specifically mention the Medicaid expansion in his comments on Tuesday.
  • South Dakota: Gov. Dennis Daugaard (R) said the state likely will not expand Medicaid coverage, at least not until 2015 or 2016, because officials still are examining the expansion's potential costs. He added that the state's participation would be contingent upon how much flexibility the state will have in administering the program. State physician and hospital groups have urged Daugaard and state lawmakers to participate in the expansion.

Meanwhile, the Republican governors of Arizona, Iowa, and New Jersey have indicated that they will address the expansion in their budget proposals, which are expected to be released in January and February.

In Montana, the outgoing Democratic governor is expected to address the issue when he offers his two-year budget proposal later this week; the state's newly elected Democratic governor must address the proposal by the end of December, according to Politico.

Click to expand a quick-to-scan graphic. (Note: Our interactive graphic is currently unavailable, but will be updated and reposted as soon as possible.)

Insurance exchanges

States also face a Friday deadline to declare whether they will create a state-run health insurance exchange or defer to the federal government to operate an exchange for them.

In recent days, officials in Alabama, Colorado, Florida, Kansas, Missouri, and Nevada indicated their positions on exchanges.

  • Alabama: Bentley on Tuesday said the state will not create its own exchange, saying, "I am not going to set up a state-based exchange that will create a tax burden of up to $50 million on the people of Alabama."
  • Colorado: The state will move "full speed ahead" on implementing a state-run exchange, according to NPR's "Morning Edition." The state has worked for 16 months to draft rules, hire contractors and apply for federal grants for the exchange.
  • Florida: Scott said he is willing to consider designing a state-operated exchange despite his previous criticism of the ACA. However, it is unlikely that the state would be able to design its own exchange because it has done little to no work on setting one up.
  • Kansas: Gov. Sam Brownback (R) announced recently that the state will not create its own insurance exchange or partner with the federal government, leaving the exchange entirely in the government's hands. Brownback in a statement said the decision was made because the state "will not benefit from it and implementing it could cost Kansas taxpayers millions of dollars."
  • Missouri: Gov. Jay Nixon (D) has said the state will not set up its own exchange after voters last week approved a ballot measure banning the governor or any state agency from setting one up without approval from the state Legislature. "Based on current state law, and the federal deadline, the state-based option isn't on the table for Missouri at this time," Nixon said.
  • Nevada: Gov. Brian Sandoval (R) maintains that the state will move forward with its own exchange. In a recent interview with Capital Public Radio, Sandoval said, "Nevadans are fiercely independent, so we made a decision to build the exchange ourselves, and we are moving forward with that."

The announcements come as concern rises over whether the federal government will be ready and able to operate exchanges for states that decide not to build their own (Cheney/Smith, Politico, 11/14; Baker, "Healthwatch," The Hill, 11/13; Beyerle, Gadsden Times, 11/13; Baker, "Healthwatch," The Hill, 11/14; AP/Florida Today, 11/13; Brokaw, AP/Bloomberg Businessweek, 11/13; Aizenman/Kliff, Washington Post, 11/13; Whitney, "Morning Edition," NPR, 11/14; Gordon, KCUR/Kaiser Health News, 11/13; Bartolone, Capital Public Radio/Kaiser Health News, 11/13).

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