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Medicaid decision pits governor against governor

The Supreme Court's decision on the Affordable Care Act was the focus at an annual governors' meeting this weekend. So far, five Republican governors have opted out of expanding their states' Medicaid program.

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For Republicans, though, the presidential election affects their decisions on the expansion. Governor Mary Fallin of Oklahoma told reporters she would decide on the option before the election, but noted the presumptive Republican presidential nominee, Mitt Romney, has said he would repeal the law.

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Her fellow Republican, Virginia Governor Bob McDonnell, a rising star in the party, would not commit to a timeframe for expanding Medicaid or for deciding on creating a state-run exchange for private insurance. His state was the first of 26 to sue the federal government over the law.

"The presidential race does impact the healthcare decision, because I don't want to spend any taxpayer money - either federal taxpayers or state taxpayers' - in building an exchange or expanding a program that may look dramatically different in six months," McDonnell said at a news conferences.

Delaware Governor Jack Markell, set to head the governors' group, embraces the expansion as the most prudent spending choice. If more people have insurance, fewer uninsured people will turn to expensive emergency rooms to treat minor issues and pass the bill onto taxpayers, the Democrat said.

"We have to understand there is a really significant cost of doing nothing and it's the cost of uncompensated care," he said in an interview.

While the governors meeting is intended as a bipartisan exchange of ideas, Markell said that the weekend's interactions would have little influence on his decision.

"Governor McDonnell and I have fundamentally different approaches to the expansion, and my guess is at the end of the day, he and I are... going to stay where we are," he told a news conference.

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