Dylan Scott is a GOVERNING staff writer.E-mail: firstname.lastname@example.org
Faced with the reality that the Affordable Care Act (ACA) will be fully implemented after President Barack Obama's reelection, Republican governors are asking for a sitdown with the White House to discuss state-level implementation -- and more time to plan their health exchanges.
The GOP governors, who will lead 30 states in January, sent a letter to Obama Wednesday as their annual conference got underway in Las Vegas. They asked for two things: more time to decide if they want a state-run health exchange and a meeting with administration officials "as soon as possible" to discuss concerns about how the ACA will affect states.
Health and Human Services (HHS) Secretary Kathleen Sebelius sent a letter to all 50 governors following the election, extending the deadline for state-federal partnership or federal-run exchanges into next year. But, for the moment, states still have to notify HHS by Nov. 16 (the original deadline for all exchange applications) if they want to pursue a state-run exchange.
The Republican governors said they need "a more manageable timeline." They also included 20 questions on the exchanges that they say must be answered before they finalize their plans. They asked another 14 about the Medicaid expansion. Many GOP officials have expressed opposition to the expansion, but Tuesday's letter indicated the governors are open to "a honest discussion on reform, flexibility and waivers to allow governors to manage Medicaid costs better."
The exchanges present an interesting connondrum for conservative state leaders. On the one hand, they are part of a federal law that Republicans almost universally despise and come with numerous federal requirements. On the other hand, foregoing a state-based exchange means letting the federal government assume a prominent role in their state's insurance market.
Some GOP governors (such as South Carolina's Nikki Haley) have remained steadfast in their opposition to implementing any part of the law, as Governing reported last week. Others (like Florida's Rick Scott) have left the door open for pursuing a state-based exchange since Obama's reelection.
The full letter from the Republican Governors Association is below.