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Supreme Court ruling on Medicaid tees up campaign issue

Some Republican governors and state lawmakers are eager to opt out of the expansion of Medicaid under 'Obamacare,' now that the Supreme Court has removed the penalty. But millions could remain uninsured. Expect this to play big in some state elections.

By Staff writer / July 3, 2012

Florida Gov. Rick Scott speaks about the supreme court's decision concerning the health care bill at a news conference on Thursday, in Tallahassee, Fla.

Steve Cannon/AP

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Washington

Just four months before Election Day, the US Supreme Court has served up a juicy campaign issue: expansion of Medicaid.

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Suddenly, states now have the option of refusing to expand eligibility for Medicaid – the federal-state health-insurance program for the poor – without penalty, under the court’s health-care ruling last week. And some Republican governors are leaping at the chance to assert their opposition to Medicaid expansion, in the name of fiscal responsibility. As a result, millions of low-income Americans who would have gained health coverage now may not.

The issue is likely to play big in competitive gubernatorial elections. Ditto races for state legislatures, which will also play a role in deciding whether a state opts out of expanded Medicaid.

Leading the charge is Gov. Rick Scott (R) of Florida, who announced Sunday that his state will opt out of Medicaid expansion, which would have covered more than 950,000 people in his state. Other GOP governors pledging to ditch Medicaid expansion include Nikki Haley of South Carolina, Bobby Jindal of Louisiana, and Scott Walker of Wisconsin. Still others, like Dave Heineman of Nebraska and Chris Christie of New Jersey, say they’re leaning against expanded Medicaid.

And in states with Democratic governors and Republican-controlled legislatures, like New Hampshire, state lawmakers say they’re already working on a plan to block Medicaid expansion.

“There’s a deep suspicion among people who didn’t like Obamacare to begin with over the costs,” says Susan MacManus, a political scientist at the University of South Florida in Tampa. “And the other side is saying, ‘Well, how can you dare leave this money on the table?’ ”

Since the Supreme Court ruled last Thursday, “the line in the sand has gotten much deeper and clearer,” Ms. MacManus says.

Under the Affordable Care Act (ACA), which goes into full effect on Jan. 1, 2014, eligibility for Medicaid expands to cover those with incomes up to 133 percent of the federal poverty line (or $25,390 for a family of three). As originally envisioned, states that choose to opt out would be penalized by losing their existing federal Medicaid funding. But the court struck down the penalty as coercive.

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