States must decide whether to create exchanges in which consumers can buy subsidized insurance policies beginning in 2014, or have the federal government do it for them. They also need to determine whether to expand Medicaid, the federal-state health-care program for the poor, to about 17 million more people, after the Supreme Court ruled that they can't be forced to do so.

States face a deadline tomorrow to tell the federal government whether they are planning to create their own exchanges. Yesterday, the Republican Governors Association sent a letter to the Obama administration, asking for more time.

Virginia Governor Robert McDonnell said the federal government hasn't provided enough information, and that he's hesitant to expand Medicaid unless the states are given more power to run the program.

“There are too many unanswered questions to make the decisions,” he said at a news conference.

Only 13 states, none led by Republicans, committed before the election to build their own exchanges.

Maine Governor Paul LePage said he has no plans to set up a state exchange where residents who don't receive health insurance through their employer can shop for subsidized plans. He plans to cede that power to the federal government.

“I'm not lifting a finger,” he said in an interview. “We're not going to get involved. We're going to let Mr. Obama do a federal exchange. It's his bill.”

Court Ruling

The president's health-care law has long drawn resistance from Republicans, who view it as a costly expansion of the federal government and sued to overturn it. The Supreme Court in July upheld the law. In the election, Obama won in states including Florida, Ohio and Wisconsin, whose Republican governors had opposed the law.

The Supreme Court's ruling gave states the power to decide whether to expand Medicaid, which now typically covers low- income parents and the elderly, to everyone with incomes up to 133 percent of the poverty line. The federal government will pay all of the cost for the first three years, with the states' share eventually rising to 10 percent.

“I don't see how we can afford it,” Georgia Governor Nathan Deal said in an interview.

Iowa Governor Terry Branstad said the law is unpopular in his state, even though Obama won there. He said he's leaning against expanding Medicaid.

“We don't want to get trapped in something we can't afford and can't be sustained,” Branstad said in an interview.

At least five Republican governors — from Texas, South Carolina, Florida, Louisiana, and Mississippi — said after the Supreme Court ruling that they opposed expanding Medicaid, while others said they were waiting until after the election. Yesterday, Florida Governor Rick Scott told the Associated Press that he wants to negotiate with the Obama administration over the law.

Republicans opposed to accepting additional federal money for Medicaid have said it could hit them with billions in added costs to cover their share, and expressed concern that Congress could shift more of the expense to the states as it deals with federal budget shortfalls.

At the meeting in Las Vegas, other governors, including Arizona's Jan Brewer and Oklahoma's Mary Fallin, said in interviews that they're still weighing their options on Medicaid expansion.

Wisconsin Governor Scott Walker said he'll announce his plans for the health-care law by tomorrow's deadline.

“It's the law and we'll comply with the law,” Walker told reporters. “The question is which way do we go about doing that.”

Bloomberg News

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