WASHINGTON -- In the wake of the Supreme Court's decision to uphold the constitutionality of the Affordable Care Act’s individual mandate, the battle over health care has shifted, in large part, to governors’ offices and statehouses across the country.
States now have responsibility to create health insurance exchanges and decide whether or not to expand Medicaid coverage. The extent to which they choose to do so could determine how people perceive the law and the actual success of reform.
In the immediate aftermath of the ruling, the response has been mixed. State level reactions to the Supreme Court’s decision have ranged from active compliance to open defiance. As HuffPost’s Amanda Terkel reported, several high profile Republican governors including Louisiana’s Bobby Jindal and Wisconsin’s Scott Walker have taken hardline stances against implementing the ACA in its entirety.
“We’re not going to start implementing Obamacare,” Gov. Jindal told reporters on a Friday morning conference call, before saying, “We’re going to work very hard to get Governor Romney elected so this law will be repealed long before the effective dates.”
On the specific issue of creating a state health insurance exchange -- which states have the choice to either set up and run themselves with government funding, or defer to the federal government to create and control -- some state lawmakers have signaled immediate opposition. Their unwillingness comes despite a January 2013 deadline for states to establish health exchange plans before the federal government does it for them.
“Senators do not intend to take up legislation this year to create a health benefit exchange,” said North Carolina Republican State Senate leader Phil Berger, “the General Assembly needs time to process and understand this mixed ruling on Obamacare.”
Though no longer mandatory, the expansion of Medicaid coverage has drawn equal ire in states. Though the ACA offers full federal funding for expanded coverage for the first three years before state contributions eventually rise to 10 percent of Medicaid costs, some Republican state lawmakers have wasted no time portraying the law as a burdensome mandate.
“If this unfunded Medicaid expansion is implemented,” said Nebraska Gov. Dave Heineman in a released statement, “state aid to education and funding for the University of Nebraska will be cut or taxes will be increased. If some state senators want to increase taxes or cut education funding, I will oppose them.”
Florida Gov. Rick Scott, whose state helped lead the legal charge against President Obama’s health care law, told WOKV in Jacksonville that he opposed an expansion of Medicaid coverage on the grounds that his state could not afford it.
Not all Republican state lawmakers took such a hardline against the ACA’s implementation. The Salt Lake Tribune reported that Utah Gov. Gary Herbert plans to follow federal health care mandates for the time being, while refusing “to do something that is going to bust our budget” in the future.
Former Office of Management and Budget director and Indiana Gov. Mitch Daniels, who plans to step down at the end of his term, took what on the surface seems a more moderate approach. Daniels said he would leave the decision on a possible Medicaid expansion to future state legislators.
Some GOP lawmakers have expressed their view that compliance with some key aspects of the health care law is a way to ensure at least some state control over the process. As CBS News reports, Republican Colorado state legislator Bob Gardner argued that by moving forward on the creation of insurance exchanges “Colorado did the right thing by having a mechanism to do its best to impose a Colorado solution.”
In a similar statement, Michigan Republican Gov. Rick Snyder expressed his belief that “working with our legislative leaders to establish the MiHealth Marketplace will allow Michiganders to make decisions regarding what will be covered as opposed to Washington, D.C., making those decisions for us.”
It remains unclear how some states will react to Thursday’s Supreme Court decision, with many lawmakers conspicuously trying to keep their future options open.
UPDATE (7/1 8:33 p.m. ET): Lane Wright, Florida Gov. Rick Scott's spokesman, told the Associated Press, "Florida is not going to implement Obamacare" and added, "We are not going to expand Medicaid and we're not going to implement exchanges."
Below, a slideshow of politicians' reactions to the Supreme Court's health care ruling: