The Supreme Court ruling still leaves Republicans with an opportunity to blow a major hole in the law: individual states can choose to opt out of the Medicaid expansion in 2014 without losing federal funding. That could leave some low-income Americans caught in a "no man's land," as my colleague Sarah explains. But Nancy Pelosi doesn't believe it's going to be a problem. "I don't think governors will turn that down. People have the need, the urgency is there," the House Democratic Leader told reporters on a press call Thursday afternoon.
Pelosi argued that it will be extremely difficult for conservative states to opt out once their residents see how other states are benefitting from the Medicaid expansion. "Once this bill is rolling and people experience benefits of it, it's very hard for a state to say [no]," she said. States will also receive full federal funding for the first three years of the expansion before they have to take up more the expense, which Pelosi described as a major incentive to get them to participate.
She did suggest, however, that there could be a future expansion of federal Medicaid funds to states after the three-year mark. "It may be, at some point, depending on economy and budgetary consideration—there may be a rethinking, if there would be matching, what that would be, beyond three years," Pelosi said. But that would require Congress to pass another bill.
Finally, Pelosi denied that supporters of Obamacare were taken aback by Court's ruling on the Medicaid, describing the Court's decision on the expansion as a "clarification" to the law that House Democrats had supported. "It's not something—'no, my God, nobody would think of that,'" she said. "We feel very comfortable going forward."
She did acknowledge, in passing, that governors did have "to make a choice" on Medicaid. But Pelosi warned against premature doom and gloom. "Emphasizing the positive on this is really important...This is a great day. This is a fabulous day," she concluded.