Obamacare: 5 states to watch

When push comes to shove, will Florida do a 180 and make way for Obamacare?
By JASON MILLMAN | 1/3/13 4:32 AM EST
States entered 2012 not knowing whether President Barack Obama’s
health care law would survive. They enter 2013 facing the reality of
impending deadlines and tough choices that can’t be put off much longer.

Even states that have turned down the chance to build their own exchanges —
about 30 in all — have about six weeks to decide whether they want to
partner with the feds on key functions. Although states don’t face a
deadline to say whether they’ll expand their Medicaid programs under the
Affordable Care Act, the clock is definitely ticking.

In some states, their paths are already set. In most,
though, state officials will wrestle with questions about the future of
their insurance markets and crunch the numbers on the ACA’s Medicaid
expansion — all as the Obama administration continues to pump out
guidance and rules to move implementation of the health law full speed

Though governors may have come out strongly one way or another on
implementation, most of them will have to face their first legislative
sessions since the Supreme Court upheld the ACA. And even if states
aren’t expanding Medicaid or setting up their own exchanges, they’ll
have to confront possible changes to state laws to align with ACA
requirements — or risk having the feds step in to regulate their
insurance markets like never before.
Here are five of the more interesting states to watch on ACA implementation in 2013:


Sure, Gov. Rick Scott said some nice things after the election about
wanting to work with the Department of Health and Human Services on ways
to implement the law in his state, which was the leading plaintiff in
the Supreme Court challenge. But when push comes to shove, will Florida
do a 180 and make way for Obamacare?

Scott is scheduled to meet with HHS Secretary Kathleen Sebelius next
week, and the state Senate recently formed a committee dedicated to
studying the state’s ACA options. If Florida decides to eventually run
its own exchange — 2014 seems to be out of the picture — state officials
have identified two programs, Florida Health Choices and Florida
Healthy Kids, as existing structures that could support the new
insurance marketplace.

It’s also hard to imagine Florida expanding its Medicaid program
after fighting so hard against the expansion before the Supreme Court.
Still, Florida is waiting on the Centers for Medicare & Medicaid
Services to rule on the state’s request to significantly expand managed
care in its existing Medicaid program, so maybe there’s some room for


Gov. Butch Otter was the only one of his Republican colleagues to
greenlight a state-based exchange after the election — the two other
Republican governors moving ahead on a state-run exchange had made up
their minds long before. But the Republican-run state Legislature could
still prevent that from ever happening.

State lawmakers in 2012 rejected a $20 million HHS grant that would
have allowed Idaho to plan for an exchange. The majority leader in the
state House of Representatives is urging Otter to let the feds set up Idaho’s exchange before rushing into anything.

Otter’s still undecided on the Medicaid expansion, which could
potentially cover an additional 108,000 people. An advisory panel he set
up in the summer recommended that Idaho expand the Medicaid program, as
long as the state could enact major reforms to go with it.