November 8, 2012 By Christine Vestal and Michael Ollove, Stateline Staff Writers
Since the day it was enacted, many of the Affordable Care Act’s opponents have preferred to treat it as provisional. First, they argued, the Supreme Court might overturn the whole law. When that didn’t happen in June, opponents turned to the hope that maybe Mitt Romney would win the presidency and repeal it.
Still, in the new reality, there remain some significant uncertainties in the immediate future of the ACA, particularly in how Republican governors, who have vociferously opposed the law until now, will react in the wake of President Obama’s victory. The ACA is indeed the law of the land and will remain so for the foreseeable future, but that doesn’t mean that Republican governors have to be full participants.
If they decline to be involved, however, they have to be willing to forego billions of federal dollars while at the same time inviting more federal involvement in their state health policies.
At issue is whether states will be willing and able to run their own health insurance exchanges — the ACA’s envisioned online marketplaces where some 30 million Americans will be able to comparison shop for private insurance plans and apply for Medicaid and federal tax credits. If states choose not to run their own exchanges, the law requires the federal government to do it for them.
States must also decide whether they want to accept generous federal funding to expand their Medicaid programs to cover millions more people. In addition to the political liability that may represent for Republicans, the expansion also comes with a future price tag some states are taking very seriously.