Medicaid expansion was challenged by 26 states as being "coercive" because it would have allowed the feds to take back all of a state's Medicaid funding if it refused to comply. But the court ruled that the U.S. Government can only take back funding designated specifically for expansion, and not any of a state's existing Medicaid funding. "What Congress can not do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding," Chief Justice John Roberts wrote for the majority.
States stand to gain a lot by expanding the program, Christine Vestal of Stateline reports, because the federal government pays 100 percent of costs for the first two years, then reduces its funding to 90 percent in 2020. The Congressional Budget Office estimates this would add up to a $20 billion transfer to states over the first 10 years of expansion. But, some states say covering 10 percent of the cost of new beneficiaries would put more strain on their budgets. (Read more)
Most Republican-led states have done little to set up online exchanges which allow residents to compare private health insurance for the best price and serve as a portal for joining Medicaid expansions, The Associated Press reports. State have to tell the federal government in November whether or not they will build exchanges. The federal government will build a common exchange for states that don't build their own.
Wisconsin's Republican Governor Scott Walker denounced the law on Thursday, saying he would not implement any parts of it in Wisconsin before the presidential election. "While the court said it was legal, that doesn't make it right," Walker said. "For us to put time and effort and resources into that doesn't make a lot of sense."
GOP leaders in Mississippi say they don't have the money to expand Medicaid. Emily Wagster of AP reports Mississippi receive a large chunk of federal money for Medicaid because it has a high percentage of low-income residents. Republican Governor Phil Bryant said deep cuts in education and transportation would have to be made to cover the cost of Medicaid for more than 400,000 additional people. He said the state is looking at "some leeway in the decision to not penalize states for not complying with Medicaid requirements."
The question of Medicaid expansion is still up in the air in several other Republican-controlled states, including Nebraska, Ohio, South Carolina and Indiana, where governors say they would be hard-pressed to implement it. But Washington Republican Attorney General Rob McKenna, who joined the lawsuit against the Affordable Care Act last year, split with most of the GOP and said Congress shouldn't repeal the law, or any of its provisions, including the individual mandate. McKenna, who's currently running for governor, said he's ready to implement health-insurance exchanges and Medicaid expansion if elected, Jim Brunner of The Seattle Times reports.