WILLIAMSBURG, Va. — Of the country’s 20 Democratic governors (plus Independent Rhode Island Gov. Lincoln Chafee), 13 — and Chafee — plan to fully implement the national health-care law’s Medicaid expansion, while seven have yet to make up their minds, USA Today reported earlier this week.
“Every governor has a unique set of challenges; some have greater political challenges to overcome than others,” DGA chairman and Maryland Gov. Martin O’Malley told reporters Saturday at the National Governors Association annual meeting.
While seven Democratic governors have yet to make up their minds on the Medicaid expansion, 22 Republican governors are undecided, as well.
Governors of both parties are still studying the potential impact of the provision and have cited a long list of questions they have about how the expansion will be carried out, which many reiterated in interviews at the leaders’ annual summit in colonial Williamsburg. The topic was also front and center at a breakfast of Democratic governors Saturday morning and at a separate roundtable of Republican governors.
The matter presents a two-fold quandary for the Obama administration. Politically, it runs counter to the White House’s argument that the debate over the health-care law has been settled and that it’s time to move on. Policy-wise, it has delivered the administration a whole new raft of questions to answer on how the law will affect the states.
O’Malley, who spoke briefly with reporters Saturday after an NGA panel on health care, argued that while some governors may be ideologically opposed to the health-care law, others may be slow-walking their decision in order to negotiate more flexibility from the federal government. That, however, could backfire economically, he contended.
“I think you’ll see that states that are too slow to find a way to implement will put themselves at an economic disadvantage as states like Maryland and other states are able to make health care more affordable for more small businesses and family-owned businesses, which are the ones that really create the jobs,” O’Malley said.
The DGA chairman also contended that political differences between governors and state legislatures are a potential reason why some Democratic governors have yet to make up their minds.
“Some of our other governors are in states with legislatures that have invested so much politically into beating the president over the head with the Affordable Care Act and to falsely portray it as welfare expansion that it’s harder for them to come to the table or even to allow those conversations,” he said.
A transcript of our talk with O’Malley follows:
Q: Where do things go from here on the Medicaid expansion issue?
“We decided early on that we would be an earlier implementer of the Affordable Care Act. ... We estimate that by 2020, this would be a net benefit to our budget of about $600 million. It also gives us the ability to create that common platform and that access to preventive care that will enable us over time to bend down the cost curve that we’ve been experiencing as a country, the ever-escalating cost of health care, which actually outpaces any increase in taxes. Businesses saw health care go up by 113 percent over the last 10 years in America, and then we wonder why we’re not investing in job creation and expanding opportunity? We’ve got a lot of capital that can be redeployed to more productive uses in our economy.
“It’s a good deal for us; we saw that right away. So we passed the statute to set up the health-care exchange. We’ve brought in all of the private partners — the brokers that sell insurance and have designed our exchange. We’ve hired the IT staff. We will meet the deadline as proposed in the Affordable Care Act, and we’re moving forward as an early implementer and are glad to assist and help other states, and in fact, already are.”
Q: What do you make of the fact that some Democratic governors are waiting before committing to implement the expansion?
“Well, it is a little different in every state. I mean, forging the consensus necessary and doing the analysis so that the stakeholders can see the benefit — I mean, that’s easier to do in some states than others. Compared to other states, it was not easy for us, but we were able to do it sooner than other states. ... Other states have other challenges.
“Some of our other governors are in states with legislatures that have invested so much politically into beating the president over the head with the Affordable Care Act and to falsely portray it as welfare expansion that it’s harder for them to come to the table or even to allow those conversations. So every governor has a unique set of challenges; some have greater political challenges to overcome than others.
“But with the Supreme Court decision giving a clear and final determination, I believe that increasingly you’ll see states and their health-care stakeholders realizing that their states will be at a competitive disadvantage — not only in terms of the financial viability of their health care institutions in the health care sector, but also, I think you’ll see that states that are too slow to find a way to implement will put themselves at an economic disadvantage as states like Maryland and other states are able to make health care more affordable for more small businesses and family-owned businesses, which are the ones that really create the jobs.”
Q: Do you think it’s better for Democratic governors facing competitive races in some states not to focus on health care?
“I think whenever we speak — whether it’s on education or affordable college, health care or public safety, it’s important that it is part of the ongoing drive to make our economy grow again, to expand jobs, and to give our kids better opportunities than the ones our parents were able to give us. I don’t think it’s an issue we should run from, but I think as Democrats, we need to do a much better job of explaining the fact that in order to be competitive, in order to grow jobs and expand opportunity, we need to stop wasting ever more and more money every year on rising, out-of-control health care costs. ... Every state should be able to find a way to craft their own path forward. Some will move more quickly than others. There’s a variety of approaches you’ll see from Democratic governors. But the direction’s always clear — it’s a direction forward, and doing it in a sustainable and fiscally responsible way, and in a way that gives their states maximum flexibility for innovation.”
Q: What about the reasons various governors who have yet to make up their minds on implementation?
“I think some people are just ideologically opposed, and will always be ideologically opposed, among the 50 governors. And then there’s another group who realizes that this one’s been resolved and the Supreme Court’s ruled and somehow they have to find a way forward, and as they search for that way forward, they want to leverage and negotiate as much flexibility from the federal government as possible, so they’re slow to necessarily lay forth their path forward. And then there’s others of us who early on saw that this was an advantage for our state, this was a good deal economically for our state as well as fiscally for our state, and those are the 11 or so that were on the front of USA Today. And you know what, there are some people in that middle category of wanting to leverage as much flexibility from the federal government as possible that are Democrats and some who are Republicans.”
Q: So you’re all right with the fact that not all Democratic governors are on board with the expansion.
“You have to acknowledge that forging a consensus in Maryland is an easier task than forging a consensus in some other states. We elect good leaders — and I think all of the Democratic governors are good leaders — to practice the art of the possible, to achieve progress for their people, all of their people. And some have easier legislatures to work with than others do right now.”
Q: How are Democratic governors feeling about the presidential race right now?
“There’s a very focused and positive mood among the Democratic governors. I think we know the road ahead is difficult; we know we have a lot more work to do, that there’s far too many people in each and every one of our states that are still looking for work, and that’s why we need to work together to create jobs and expand opportunity and overcome this brief period of jobs obstruction that’s taken over the tea-party, Republican House. And that’s what we need to punch through, and re-elect the president and also re-elect Democratic governors, and more of them.”