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As governors from around the country meet this weekend in Williamsburg, Va., health care is near the top of their agenda. Specifically, what to do about the federal health law, now that the Supreme Court has given states new options.
Republican governors in particular said they were genuinely surprised by the Supreme Court ruling. The justices declared the health law in general constitutional, but gave states the option of whether or not to dramatically expand their Medicaid programs. They'll now get to choose whether to put most people who earn more than about $15,000 a year on the program or not.
"I think a lot of us, certainly on the Republican side, believed it would be found unconstitutional. So I think it's just added more confusion to the issue rather than settling the issue," said Utah Gov. Gary Herbert, "and probably more impetus on the November election to really find out and sort out what the implications are going to be going forward."
Indeed, the meeting's host, Virginia Gov. Bob McDonnell, said he wasn't planning to say yet whether his state would expand its Medicaid program, even with the federal government picking up the vast majority of the costs.
"Honestly, I don't think it's responsible fully for my state to make a decision now because there's still more information we need," he said.
Many Democratic governors see things differently, however, including Delaware's Jack Markell, the incoming chairman of the National Governors Association.
"This is not political. This is a financial analysis of what does it mean to cover, in our case, an additional 30,000 people," he said, "and my view — and we're clarifying that we're understanding it all properly — ... is that this is absolutely a good deal for Delaware taxpayers."
Unlike Republicans, who say the Supreme Court decision confused matters, Democrats like Maryland's Martin O'Malley also insisted that it should have ended the debate.
"I think most governors understand that the Supreme Court's decision was a final and clear ruling," he said.
Other Democrats were less charitable. Vermont's Peter Shumlin said some of his Republican colleagues aren't being honest by calling for the repeal of the health law on the one hand, while declining to say whether they'll accept the federal Medicaid funding that flows from it on the other.
"Have a spine. The American people are sick and tired of spineless politicians. [Either] say, 'I believe the Affordable Care Act is the wrong thing, so I will not take the loot,' or say, 'I believe the Affordable Care Act will help my state cover uninsured Americans, grow jobs, economic opportunities, and I'm taking the loot,' " Shumlin said. "But to say, 'I'm gonna criticize the plan, but I won't tell you whether I'm taking the loot or not until after the election,' that's what breeds cynicism among the American people."
O'Malley of Maryland thinks most of those Republican governors will eventually come around and take the money for economic — if not political — reasons.
"Once the posturing of the election is past, I think that a lot of these governors are going to have a hard time going home to their doctors, nurses, hospitals and explaining to them why they are passing up an opportunity to transform these dollars into better economic uses for job creation in their states," he said.
But for many Republican governors, like Nebraska's Dave Heineman, it's about something bigger than parochial interests.
"They all say it's free federal money. No, it's not. That's our tax dollars," he says. "It's costing every one of us."
Behind the scenes at the meeting, however, governors did seem to agree on one thing. There are still lots of questions they want the federal government to answer about how they will all work together as the health law's implementation proceeds.