Governors Spar Over Medicaid And Health Exchanges

Jul 13, 2012
Originally published on July 13, 2012 10:24 pm

The nation's governors — well, many of them, anyway — are gathering in Colonial Williamsburg, Va., for their annual summer meeting this weekend.

It's no easy trick for the National Governors Association to get Republican and Democratic chief executives on the same page, or even the same room.

This year, in the wake of the Supreme Court decision on the Affordable Care Act, it's even harder.

The decision upholding the law means state insurance marketplaces, or exchanges, for individuals and small businesses aren't going away. The exchanges, which can be set up by each state or put together by the federal government, need to be running by the fall of 2013.

Governors need to decide soon whether to go ahead with their own exchanges or let the feds do the job.

The high court ruling did make it optional for states to expand Medicaid to cover more low-income people. So governors have to decide whether their states will go ahead with that, or not, too. Quite a few have already said no.

The meeting kicked off Friday with dueling news conferences. On one side, Virginia Republican Gov. Bob McDonnell, host of the meeting, said it would be irresponsible to expand Medicaid, unless it is dramatically overhauled first.

His neighbor Democratic Gov. Martin O'Malley of Maryland said in a separate news briefing that he thinks his state will gain a competitive advantage by being early to expand Medicaid and adopt other aspects of the health care law.

What do the governors have in common? All of them are worried about money.

Unlike the federal government, the governors say they can't print more money. They have to balance their budgets every year. So they're wrestling with how much health care they can afford to provide, even with federal subsidies under the recently upheld law.

Delaware Democratic Gov. Jack Markell told me, "We've taken a hard look, and we have the opportunity to significantly expand the number of people in Delaware who have care. There's sufficient federal resources to pay for it. We think this is a good deal for the people of our state."

Nebraska GOP Gov. Dave Heineman held a different view on a Medicaid expansion. "Until you can prove to me it won't result in cuts to public schools in our state, to the University of Nebraska or state colleges or community colleges, or increases in taxes, then I'm not ready to move in that direction," he said in a scrum after a press conference.

Copyright 2018 NPR. To see more, visit


The nation's governors - well, many of them - are gathering in Williamsburg, Virginia, for their annual summer meeting this weekend. The National Governors Association has been struggling in recent years to keep its Republican and Democratic chief executives - if not on the same page - at least, in the same room. But, this year, in the wake of the Supreme Court decision on the health care law, that's proving harder than ever.

We sent NPR's Julie Rovner to Williamsburg for the meeting and she joins me now. And Julie, how many governors are there?

JULIE ROVNER, BYLINE: Well, not all of them. It's a little bit more than half of them, which is not a bad turnout for the summer meeting, where you don't always get everybody. You know, the governors are here to try to find common ground on things like economic development and transportation, energy and, yes, health care, but you know, as the parties have become more polarized, that's gotten a little bit harder.

BLOCK: And how much attention is health care getting from the governors there?

ROVNER: Well, you know, health care is not actually technically on the agenda, although tomorrow there will be a discussion about how to try to find some cost savings in the Medicaid program, but since the Supreme Court, just two weeks ago, made the Medicaid expansion part of that law optional, every governor has a big decision to make about whether or not their state is going to go forward with that. So, obviously, they want to talk about that amongst each other and with the media.

BLOCK: And that discussion has started well in advance of that meeting in Williamsburg, Julie.

ROVNER: Yes. It's been going on for a while, but no sooner did the governors get to Williamson, then they launched right back into it. There were dueling news conferences this morning, the first one, the host governor, Governor Bob McDonnell from Virginia, who's being considered as a possibility for the Republican national ticket, said that he thinks it would be irresponsible to expand Medicaid unless it was dramatically changed.

Meanwhile, just across town, the Democratic Governors Association had their own press conference and Governor Martin O'Malley of Maryland said that he thinks that his state's going to get a competitive advantage, not just from doing the Medicaid expansion, but from implementing other parts of the health law early.

BLOCK: And one other part of the health law, Julie, that's been a hot topic has been about state health insurance exchanges and whether states are going to go ahead and set those up. What are the governors saying about that?

ROVNER: That's right. This was always considered optional for the states. States get to decide whether or not to have these marketplaces, places where individuals and small businesses will go to shop for insurance, and the states have a choice of putting together these exchanges themselves or having the federal government come in and do it for them. About a dozen states have said they're going to do that. A lot of states are still waiting and, you know, for a while, they were saying they're going to wait until the Supreme Court rules to decide whether to do it now. They're saying, well, the Supreme Court's ruled. They're going to wait and see what happens after the election.

So, again, governors are trying to figure out where to go, but the time is starting to run short. These exchanges really need to be up, running and ready to go by next fall, by the fall of 2013, and so there's a lot of concern that, if the states don't really get up and get planning and get going now, it could be too late.

BLOCK: Julie, as you talk to the governors there, are you hearing any common ground, any agreement between the Democrats and the Republicans?

ROVNER: Well, you know, it's funny. I think the one thing that they definitely agree on is that everybody's worried about money. It's just that, when they look at this law, they see dramatically different things. Some states look at the money, particularly for the Medicaid expansion, and see it as a good deal. They see it as a way that it will help pay for low income people in their states to get health insurance. Those are obviously mostly Democrats.

Republicans, on the other hand, look at it and worry about what it might cost them in the long run. They see money as not necessarily free money from the federal government, but they see it as their own taxpayers' money. They worry that the federal government might not be there down the line and what all the governors say is that, you know, unlike the federal government, they can't print money. They have to balance their budgets every year. They want to do the right thing and they're just worried that they want to know what the right thing is in this case.

BLOCK: NPR's Julie Rovner at the annual meeting of the National Governors Association in Williamsburg, Virginia. Julie, thanks so much.

ROVNER: You're very welcome. Transcript provided by NPR, Copyright NPR.