Now With Ability to Opt Out, State Leaders Express Reluctance to Expand Medicaid

The Affordable Care Act is safe, but many of its opponents are seizing on language in the Supreme Court ruling that says states can opt out of a critical part of the law.

Governor Nathan Deal, speaking at a press conference,  said he’d be waiting until the November election to make a decision about any state Medicaid expansion.

“It’s still too early for me to make a judgment call on that.”

Deal and others are hoping Republican nominee Mitt Romney takes the White House and follows through on his promise to repeal the law.

In the meantime, many of the law’s opponents are taking solace in the fact that the Supreme Court struck down a key provision that forced states to expand its Medicaid rolls. Under the law, the federal government could have stripped states of all Medicaid funding if they didn’t agree to expand. The justices, by a 7-2 vote, said that was overly coercive.

“This is the first time that the Court has held that an act of Congress has exceeded its powers under the Spending Clause,” said Nels Peterson of the state attorney general’s office. He helped develop Georgia’s lawsuit against the health reform law.  

“There’s going to be a lot of policy calls for the policymakers to make as a result of this decision.”

State leaders estimate the expansion will cover an additional 600,000 to 700,000 Georgians. From 2014 to 2020, it’s expected to cost the state $2-3 billion.

Greensboro Republican Mickey Channell, chair of the powerful House Ways and Means committee, said Medicaid is already $300 million in deficit for the upcoming year. He said lawmakers should take a serious look at opting out of the expansion.

“It becomes a policy question – policy based on available funds and where we can spend those funds,” said Channell. “I think certainly that the state of Georgia will take a long hard look at where we are  now.”

But many health reform advocates say opting out wouldn’t make financial sense for Georgia. The federal government is going to cover the full cost of the expansion for the first three years, and phase down to about 90 percent from then on.

State representative Pat Gardner (D-Atlanta) said Georgians would be paying for health reform no matter what – they might as well reap its benefits.

“We’re going to pay for it anyway as taxpayers so wouldn’t you just as soon have some of it come to Georgia instead of New York.”

Meanwhile, Georgia’s Department of Community Health is currently developing an overhaul of the state Medicaid system. Experts believe the agency will turn to more managed care for the elderly and disabled in order to cut costs.