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Medicaid Expansion Already An Issue In Some Gubernatorial Races

Hours after the Supreme Court upheld President Barack Obama’s health law but made its Medicaid expansion optional, Missouri Republican gubernatorial candidate Bill Randles said the state would be foolish to expand the health insurance program for the poor — even it means passing up hundreds of millions of federal dollars.

“States that accept this new Medicaid program will essentially be accepting total, government-run healthcare,” Randles, who is an attorney and an ordained minister, wrote on his campaign website.

There are 11 gubernatorial campaigns this year, including six like Missouri that have incumbents running for re-election. And experts say the health law – and specifically, whether states should opt into an expansion of Medicaid to cover more low-income people – is expected to come up in many of those. “Medicaid will be an issue anywhere Democrats have a chance to win,” said Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University. That includes states such as West Virginia, North Carolina, Washington state and possibly Missouri, he said.

The federal government is paying all of the costs for Medicaid expansion from 2014 to 2017; thereafter states have to pick up some of the added cost, but no more than 10 percent starting in 2020.

The other states with gubernatorial races are Delaware, North Dakota, Utah, Vermont, Indiana, Montana and New Hampshire.

Randles, who is vying for the Republican gubernatorial nomination in Missouri against businessman Dave Spence, said he believes Medicaid will be a “critical issue” in the election. Spence also opposes the expansion, which would cover more than 200,000 Missouri residents. The winner of the August primary will take on incumbent Gov. Jay Nixon, a Democrat, who has yet to take a position on the expansion.

Robert Blendon, professor of health policy and political analysis at Harvard, said that while Medicaid is a complicated topic, the candidates will debate whether their states should implement the law by creating new online insurance marketplaces and expanding coverage for the poor.

“Democratic candidates will say we should implement the law and put in exchanges and go after as much funding for coverage as possible, while Republican will say it’s too expensive,” he said.

That dynamic is already playing out in North Dakota, where Gov. Jack Dalrymple, a Republican, opposed the health law and reiterated that opposition after the high court’s ruling. “The health care plan is wrong for North Dakota,” he said last week. Dalrymple has not decided, however, whether to opt in to the Medicaid expansion, his spokesman said.

Ryan Taylor, his Democratic challenger, argues that expanding Medicaid “is an easy decision for North Dakota” for moral as well as financial reasons.

North Dakota is the one state where Republicans will have difficulty saying they can’t afford expanding Medicaid. In the midst of an oil and natural gas boom, the state is projecting a surplus of nearly $850 million for fiscal 2012.

Taylor, currently a state senator, said the Medicaid expansion would cover half the state’s 68,000 uninsured residents while increasing state spending on Medicaid by only 1.4 percent. Although Taylor said he expects the health law to be an issue in the campaign, he said it would take a back seat to how the state will manage its rapid growth.