In the States, Voices of Determination on Implementing Obamacare

Following the Supreme Court’s landmark decision on the Affordable Care Act (ACA),  local and national attention has once again focused on the states as the arenas where implementation of – and opposition to – the law will play out. For uninsured individuals and families who hope to gain from the expanded coverage provided for under the law starting in 2014, the initial response in many states may not have been encouraging.

Tea-party governors and right-wing state legislators, more concerned with adhering to anti-government ideology than addressing the needs of their constituents and states, have been quick to express their opposition to the expansion of Medicaid, with some going further by saying they want to cut their current Medicaid programs, reject the creation of exchanges, or even back dubious efforts to “nullify” the ACA, all the while betting that the November elections will result in eventual repeal or administrative obstruction of the law.

But in the face of this predictable response from opponents, responsible state legislative leaders from around the nation have also been speaking out. They have been voicing their determination to implement the ACA fully, underscoring the benefits of many provisions of the law for their constituents, pointing out the foolishness of rejecting the Medicaid expansion, and calling for cooler and more practical heads to prevail going forward (including, in states such as Washington and Iowa, proposing statewide summits). Members of the Working Group of State Legislators for Health Reform – who filed two amicus briefs defending the ACA with the Supreme Court earlier this year signed by over 500 lawmakers from all 50 states – have been actively driving the debate.

Here is just a sampling of the voices of Working Group members in the media in the days since the Supreme Court decision:

State Rep. Sharon Treat (ME), who worked with a network of lawmakers from other states to fine-tune the national law, called the decision ‘an incredible victory’ for tens of thousands of families across Maine. Treat, of Hallowell, called on state officials to put aside politics and implement the law. She said it will give a family of four in Maine earning the median income of $46,000 a year a tax credit that would cover nearly 80 percent of the family's total cost of health care for the year.” – Associated Press, 6/28/2012

State Sen. Jeremy Nordquist (NE) pledged ‘a battle’ between the legislature and Republican Gov. Dave Heineman…. Heineman told legislators on Thursday that he opposes an expansion of Medicaid in Nebraska, saying that those who support this would in effect cut back education. Nordquist disagreed, saying that the state's investment would bring in federal dollars to help the economy. ‘Those are dollars that pay doctors, nurses and staff,’ he said. ‘It would be ridiculous to turn [them] down.’” – Huffington Post, 6/28/2012

“[Washington] State lawmakers and health leaders say they're grateful that Thursday's U.S. Supreme Court decision upholding the federal health-care law has ended the legal limbo they've all been stuck in since last year.  ‘This whole case has caused chaos,’ said Democratic state Sen. Karen Keiser (WA), chair of the state Senate health-care committee. ‘Over the last six months, we've had nothing but chaos and confusion.’ Now the plan is to move quickly to start bringing a good part of the state's 1 million uninsured onto health insurance, either public — through a major expansion of Medicaid — or private.” – Seattle Times, 6/28/2012

[State Rep. Garnet] Coleman (TX)  said he expected [Texas Gov.] Perry and the state’s lawmakers to continue their refusal to establish a state-based Small Business Health Options Program, or SHOP health insurance exchanges… [and] that Perry and friends may also reject the federal government’s expanded Medicaid offerings. The court said today that states can’t be penalized for refusing to join the expansion by losing all of their federal Medicaid funds. If they reject it, Coleman said, ‘they’re going to have to have a long conversation with families of the mentally ill who are on the streets of every Texas city. They’re going to have to have a long conversation with people who have cancer and who are too poor to get health care or people who have diabetes.’” – Houston Chronicle, 6/28/2012

 “[State] Sen. Jack Hatch (IA)… said [Iowa Gov.] Branstad is incorrect to say Medicaid expansion would cost the state. He said that in fact, the expansion would save the state money it now is spending to subsidize care for some poor, childless adults…. Hatch presented figures from the Legislative Services Agency estimating state and local governments would save $50 million if Medicaid picks up people now on IowaCare. Hatch has proposed that the state hold a summit meeting soon to discuss what to do now that the Supreme Court has upheld most of the federal health-reform law.” – Des Moines Register, 7/2/2012

 “In New Mexico, Republican Gov. Susana Martinez has supported increased state money for Medicaid since taking office last year, though she hasn't decided whether to back the federal expansion to 133 percent of the federal poverty level – an amount equivalent to $14,856 annually for an individual or $30,657 for a family of four…. ‘I think New Mexico would be foolish not to expand its Medicaid program,’ said state Sen. Dede Feldman (NM), a Democrat, who is chairwoman of a legislative study committee that deals with health care.” – Associated Press, 6/29/2012

“North Carolina lawmakers have no plans to meet a deadline to create a new one-stop shop to help individuals and small businesses find affordable health insurance despite Thursday's landmark U.S. Supreme Court ruling…. But with much of the groundwork for a North Carolina exchange already laid, lawmakers could readily adopt changes next year, said State Rep. Verla Insko (NC), one of the Legislature's authorities on health policy.” – Associated Press, 6/28/2012

 “State Rep. Elizabeth Ritter (CT), co-chairwoman of the legislature’s Public Health Committee, said the Supreme Court’s decision allows the state to move toward full implementation of the law ‘with the certainty that we have a strong federal partner.’… Ritter estimated that Connecticut’s uninsured population, which stands at about 380,000 individuals today, will drop by about 170,000 once the law is fully implemented.” – CT News Junkie, 7/2/2012

 “State Sen. Joe Bolkcom (IA): ‘This is a great day for uninsured Iowans and for everyone struggling to pay health care bills. We succeeded in bringing affordable health insurance to every Iowa child because the federal government was our partner. Today’s Supreme Court decision means the federal government will now be our partner in bringing stable, secure health care to every Iowan. It is time to set aside inflammatory political rhetoric and get back to working together to improve the health care of all Iowans.’” – Des Moines Register, 6/28/2012

State Rep. Erin Murphy (MN) called the ruling ‘a truly historic moment for the country.’ In a statement, Murphy said, ‘Moving forward, I hope we can push aside the political stalemate of the last two years and work together with Republican colleagues to effectively implement these policies so Minnesotans and people across the country can reap the benefits for themselves, their families, and their communities.’” – Minnesota Public Radio, 6/28/12

As this recent infographic released by Progressive States Network illustrates, the fates of vast numbers of uninsured individuals and families will depend on upcoming decisions in the states. Refusing to expand Medicaid will not only cost families their health security, it may also cost states billions. As conservative governors in particular seem set to continue fighting every aspect of the law at every point in the process, it’s worth remembering that, as U.S. Senator Tom Harkin (IA) commented, “it’s going to be up to the legislatures to decide this, not just the governors.”