Six Governors Say They Will Opt Out of Medicaid. How Long Will They Hold Out?

Texas Gov. Rick Perry declared Monday his state would not participate in the health law’s Medicaid expansion, becoming the sixth Republican governor to make such a promise. Taken together, those governors opting-out would single-handedly shrink the Medicaid expansion by nearly 4 million people.

While the stakes are high for the White House, the territory is by no means uncharted. Washington has twice faced off with states over federal health care expansions, when Medicaid initially launched in 1965 and with the Children’s Health Insurance Program in 1997. In both cases, all 50 states ultimately signed up – but not without some wrangling.

Senior administration officials look to that history with optimism. “When Medicaid was enacted with a much smaller federal share…the states all ultimately came in,” White House Chief of Staff Jack Lew told ABC’s This Week.

Some Medicaid experts, however, see a different history lesson. They say that previous experience shows expanding coverage to be a difficult endeavor that could take years to complete. “It may take a little bit of time,” said Charles Brecher, a professor of public and health administration at New York University.

by Sarah Kliff at The Washington Post

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