Health Care


This is WEEKEND EDITION from NPR News. I'm David Greene.

The nation's governors - well, just over half of them at least - are meeting this weekend in Williamsburg, Virginia. The setting may be colonial but the governors are talking about some very modern problems. Near the top of their agenda is health care. The Supreme Court's recent ruling on the federal health law gave states new options and some big decisions.

Here's NPR's Julie Rovner.

JULIE ROVNER, BYLINE: Republican governors in particular said they were genuinely surprised by the Supreme Court ruling. It declared the health law in general constitutional, but gave states the option of whether or not to dramatically expand their Medicaid programs. They'll now get to choose whether to put most people who earn more than about $15,000 a year on the program or not.

Gary Herbert is Utah's GOP governor.

GOVERNOR GARY HERBERT: I think a lot of us, certainly on the Republican side, believed it would be found unconstitutional. So I think it's just added more confusion to the issue rather than settling the issue. And probably more impetus on the November election, to really find out and sort out what the implications are going to be going forward.

ROVNER: Indeed, the meeting's host, Virginia Governor Bob McDonnell, said he wasn't planning to say yet whether his state would expand its Medicaid program, even with the federal government picking up the vast majority of the costs.

GOVERNOR BOB MCDONNELL: Honestly, I don't think it's responsible fully for my state to make the decision now because there's still more information I need.

ROVNER: That's not how many Democratic governors see things, however. Delaware's Jack Markell is the incoming chairman of the National Governors Association.

GOVERNOR JACK MARKELL: This is not political. This is a financial analysis of what does it mean to cover, in our case, an additional 30,000 people. And my view is that - and we're clarifying that we're understanding it all properly. My view is that this could absolutely be a good deal for Delaware taxpayers.

ROVNER: And unlike Republicans, who say the Supreme Court decision confused matters, Democrats like Maryland's Martin O'Malley insist that it should have ended the debate.

GOVERNOR MARTIN O'MALLEY: I think most governors understand that the Supreme Court's decision was a final and clear ruling.

ROVNER: Other Democrats were less charitable. Vermont's Peter Shumlin says some of his Republican colleagues aren't being honest, by calling for the repeal of the health law on the one hand, while declining to say whether they'll accept the federal Medicaid funding that flows from it on the other.

GOVERNOR PETER SHUMLIN: Have a spine. the Americans people are sick and tired of spineless politicians, and say I believe the Affordable Care Act is the wrong thing so I will not take the loot. Or say I believe the Affordable Care Act is going to help my state cover uninsured Americans, grow jobs, economic opportunities, and I'm taking the loot.

But to say I'm going to criticize the plan but I won't tell you whether I'm taking the loot or not until after the election, that's what breeds cynicism among the American people.

ROVNER: Maryland Democratic Governor O'Malley thinks most of those Republican governors will eventually come around and take the money for economic if not political reasons.

O'MALLEY: Once the posturing of the election is past, I think that a lot of these governors are going to have a hard time going home to their doctors, nurses, hospitals, and explaining to them why they are passing up an opportunity to transform these dollars into better economic uses for job creation in their states.

ROVNER: But for many Republican governors, like Nebraska's Dave Heineman, it's about something bigger than parochial interests.

GOVERNOR DAVE HEINEMAN: They all say it's free federal money. No it's not. That's our tax dollars. That's our tax dollars we're paying to the federal government, so it's not free. It's costing every one of us.

ROVNER: Behind the scenes at the meeting however, governors did seem to agree on one thing. There are still lots of questions they want the federal government to answer about how they will all work together as the health law's implementation proceeds.

Julie Rovner, NPR News, Williamsburg Virginia

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