More state leaders considering opting out of Medicaid expansion

“They are going to be camping out at the doorstep. And they will do that in all 50 states,” he said.

White House officials contend that this is only one of several reasons the vast majority of states will eventually go along with the Medicaid expansion — which, beginning in 2014, will open the program to people with incomes at 133 percent of the federal poverty level, a far more generous standard than what most states currently offer.

Graphic

Who could fall between the cracks?

More from PostPolitics

How the IRS scandal helped immigration reform

Chris Cillizza and Sean Sullivan

THE FIX | Washington simply can't walk and chew gum.

Bachmann’s absurd claim of a vast IRS health database

Glenn Kessler

FACT CHECKER | Rep. Michele Bachmann claims the IRS will have control of a vast database with the most intimate health-care secrets of Americans. Not so.

Full text of President Obama’s speech on national security

Washington Post Staff

“We must define the nature and scope of this struggle, or else it will define us,” the president said.

Read more

On ABC’s “This Week” on Sunday, White House Chief of Staff Jacob J. Lew noted that the government will pay the full cost of covering the newly insured in the first three years, and never less than 90 percent after that.

“It is the most generous federal match in the history of Medicaid,” he said. “And I think a governor’s going to have to answer to their own people. . . . For those few that are slow to come in, they’re going to have to answer to people why they’re turning this down and why they’re letting people go without coverage.”

Republicans counter that the state share of the tab could still prove crippling. And the argument offers a chance to hammer home a major GOP talking point: that the government cannot keep growing without fraying at the seams, said Rich Galen, a Republican strategist who served as press secretary for then-House Speaker Newt Gingrich (Ga.).

“The issue is: If you keep expanding unemployment insurance and expanding Medicaid and expanding food stamps, then sooner or later the money runs out and you become Greece or Spain or Italy,” Galen said. “They’re not saying, ‘I want people dying in the streets.’ They’re saying they want to fix the economic infrastructure.”

Several analysts suggested that governors could be playing for leverage to gain more flexibility to shape their Medicaid programs in the event that Obama is reelected.

“It’s a fantastic negotiating strategy,” said Robert Laszewski, a health-care consultant and former insurance executive.

He predicted that governors could push Obama for permission to privatize parts of their Medicaid programs or to open eligibility only to those with incomes up to 100 percent of the poverty level instead of 133 percent. They also could request that the federal contribution to Medicaid be sent to them as a block grant without strings attached.

“I think they’re going to work themselves a much better deal than they would have had and then declare a Republican victory, because they’re essentially going to get some form of Republican Medicaid reform,” Laszewski said.

Still, Wisconsin Gov. Scott Walker (R) is one of several who said they are waiting for the November presidential election in hopes that a victory by Mitt Romney could empower the GOP to repeal the overhaul.

And if the law survives the election, would Walker favor expanding his state’s Medicaid program? “It’s premature to comment on that,” said his spokesman, Cullen Werwie.