Governors put off health care decisions

WILLIAMSBURG, Va. -- Millions of uninsured people may have to wait until after Election Day to find out whether and how they can get coverage through President Barack Obama's health care law.

More than two weeks after the Supreme Court gave the green light to Obama's signature legislative achievement, many governors from both parties said they haven't decided how their states will proceed on two parts under their control: an expansion of Medicaid, expected to extend coverage to roughly 15 million low-income people, and new insurance exchanges, projected to help an additional 15 million or so purchase private insurance.

In Colorado, Oklahoma and Wyoming, governors were crunching the numbers to determine what's best for residents. In Virginia, Nebraska and Wisconsin, Republican governors said not to expect a decision before Obama and Mitt Romney square off in November.

If Romney wins, the argument goes, he'll work to throw out the health care overhaul, and the issue will be moot.

"I don't think I can look the taxpayers of Virginia in the eye and say I'm going to spend a lot of your money building exchanges that four months from now I may not need," Gov. Bob McDonnell (R-Va.) said on the sidelines of the National Governors Association meeting.

The high court upheld the requirement that individuals have insurance or pay a fine, but the justices undercut Obama's plan to get almost all Americans insured, ruling that states can opt out of the expansion of Medicaid, the government-run insurance plan. Those earning up to 138 percent of the federal poverty level qualify for Medicaid under the law, except in states that reject the expansion.

The Obama administration said last week that people won't be fined for not having insurance in states that turn down the expansion, meaning the hard-fought overhaul could fall far short of the 30 million or more uninsured Obama had hoped would get coverage.

Also left to the governors is what to do about the exchanges, Internet-based markets designed to offer one-stop shopping for insurance, that are part of the law. States are supposed to set up their own exchanges, but if they don't, the federal government will run them.

About a half-dozen states have announced plans to forgo the Medicaid expansion and relinquish the massive infusion of federal dollars that would come along with it.