Virginia and Maryland are on opposite sides of a vast divide in implementing the mandates of Obamacare to provide benefits and health care.
Virginia Gov. Bob McDonnell, following the lead of other Republican governors, is threatening to back out of the Patient Protection and Affordable Care Act's widespread Medicaid expansion unless reforms are enacted to curb the program's escalating costs.
"The only way you'll see governors choose to expand, certainly Republican governors, is if there's a willingness of the administration and the Congress to do dramatic reforms to cut the cost," McDonnell said.
Virginia originally prepared for the Medicaid expansion, which includes increasing the number of eligible beneficiaries, but the Supreme Court ruled this year that the federal government could not require participation. The current budget, passed before the high court's decision, includes $1.2 billion in federal funds for the expansion and an additional $44 million, including $22 million in state funds, for changes in Medicaid related to the expansion.
Maryland, meanwhile, plans to take advantage of the federal government's offer to fully fund the expansion for the first three years. However, the state must pick up 10 percent of the load after that, and it's unclear how the state will pay for it.
At $7,352, Maryland is 11th in the nation in Medicaid spending per enrollee. Virginia is 25th with $5,870 per enrollee.
"We recognize it's not forever, but it gets people under care, under coverage," said Maryland Lt. Gov. Anthony Brown.
"We certainly have a number of years to plan and prepare for the day when it's more like a 50-50 match. But we think it would be foolish for Maryland if we did not participate."
- Steve Contorno