State and federal lawmakers opposed to President Obama's health care law are wasting no time mapping out ways to undermine the Patient Protection and Affordable Care Act despite last week's Supreme Court decision upholding the law.
A trio of congressional lawmakers on Monday wrote to all 50 governors, urging them not to create the state-run health insurance exchanges that the law requires.
"Now that we know the courts will not save us from this harmful and unsustainable law, we urge all governors to join our fight for full repeal by stopping its implementation," Sen. Jim DeMint, R-S.C., said in the letter signed by Reps. Michele Bachmann, of Minnesota, and Jim Jordan, of Ohio.
The insurance exchanges are intended to ensure that all state residents can buy private health insurance, as the federal law requires. If a state doesn't set up an exchange, the federal government would step in and create it. Forcing the federal government to set up multiple exchanges could delay implementation of the health care law beyond its planned 2014 start, officials said.
"The red states are simply refusing, and the blue states haven't gotten them done on time," Mike Tanner, a health care policy scholar at the Cato Institute, told The Washington Examiner. "The big question is, can the federal government set up 30-odd exchanges in the next two years? A lot of people doubt that."
Some governors are already fighting a second provision of the new health care law, one that would expand Medicaid, the state-federal health care program for the poor. The Supreme Court struck down a provision of the law that would have allowed the federal government to withhold all Medicaid funding from states that refuse to expand the program. Without the threat of lost funding, Republican-led states are more likely to balk at an expansion.
James Frishe, majority whip for the Florida State Legislature, told The Examiner that the Medicaid expansion would add up to 5 million people to the program in Florida alone, at a cost of more than $1.5 billion annually.
"Any way you look at it, it would require a major tax increase to maintain our budget," Frishe said.
Republican governors in Florida, Louisiana and South Carolina already are refusing to expand Medicaid or create the insurance exchanges.
"I don't think it makes sense to do those," Louisiana Gov. Bobby Jindal said on NBC's "Meet the Press." "This is simply growing government health care."
Wisconsin Gov. Scott Walker hasn't said whether he'd expand Medicaid, but he is ruling out creating an insurance exchange.
The federal health care law would expand Medicaid to cover all single adults living below 133 percent of the poverty level. Tanner said that would likely draw into the program mostly single men, many of them homeless with costly health problems, including drug and alcohol addictions.
Governors argue the Medicaid expansion would impose massive new costs on cash-strapped states even though the federal government would cover those costs at first.
Supporters of the federal health care law say the governors' refusal to implement parts of it isn't really just about saving money.
"It's a nullification strategy," Robert Kraig, executive director of Citizen Action of Wisconsin, said. "These states are trying to nullify the health care law, and Walker is one of the leaders of that group."