States Are Focus of Effort to Foil Health Care Law - Expanding Medicaid is critical to the law’s goal of covering the nation’s 48 million uninsured. Hospitals and insurers were also counting on more Medicaid patients to make the economics of the law work.

From The New York Times:

The federal government is again open for business, and Republicans in Washington are licking their wounds from the failed Tea Party attempt to derail President Obama’s health care overhaul. But here in Virginia’s capital, conservative activists are pursuing a hardball campaign as they chart an alternative path to undoing “Obamacare” — through the states.

“This has been one of those trench warfare kind of efforts for a year now, and I think it is one of those hidden stories of the whole fight against Obamacare,” said Tim Phillips, president of Americans for Prosperity. “It’s not flashy; it’s just in a whole bunch of state capitals and in the districts of a whole lot of state legislators, but it’s such a crucial aspect of the overall long-term effort to roll back Obamacare.”

The state-by-state strategy represents a split from the course pursued by Heritage Action for America and its sister organization, Heritage Foundation, which drove the “defunding Obamacare” movement that led to the recent government shutdown. In an opinion article published Friday by The Wall Street Journal, Jim DeMint, the foundation president, made no apologies. “Obamacare will now be the issue for the next few years,” he wrote.

Expanding Medicaid, a joint federal-state program for the poor, is critical to the law’s goal of covering the nation’s 48 million uninsured. Hospitals and insurers were also counting on more Medicaid patients to make the economics of the law work. For states, the terms seemed attractive: The federal government would pay 100 percent of the cost of new enrollees for the first three years, 90 percent after that.

But in June 2012, the Supreme Court ruled that states could opt out of Medicaid expansion. The ruling opened the door for conservative opponents of the law. Americans for Prosperity, with paid staff members in 34 states, walked through it. So did another group, Tea Party Patriots, which recently gave $20,000 to organizers of a referendum drive to put the question of Medicaid expansion on the Arizona ballot.

Americans for Prosperity has spent millions in states around the country, including Arkansas, Florida, Ohio, Louisiana, Michigan and Pennsylvania, to run the kind of aggressive campaign that it is now waging here in Virginia, where much will depend on the governor’s race. The Democratic candidate, Terry McAuliffe, who leads in the polls, favors expansion. The Republican candidate, Kenneth T. Cuccinelli II, is opposed.

 

So far roughly half the states are moving forward with Medicaid expansion, and an increasing number of Republican governors are expressing interest. Michigan, where Gov. Rick Snyder recently signed Medicaid expansion legislation into law, was “a tough loss,” Mr. Phillips conceded. In Ohio, Gov. John R. Kasich wants to expand. So does Gov. Tom Corbett in Pennsylvania, even though the legislature has already rejected it.