The  head of Medicare and Medicaid has sent out a plea to states, especially  Republican-led states, to expand Medicaid in accordance with the  Affordable Care Act. The US Supreme Court in upholding the law also  struck down a federal requirement to expand Medicaid. The Court said the  decision was that of the states and the federal could not punish states  who did not choose to expand Medicaid.

Opposition  to Obama's signature domestic policy achievement has become a rallying  cry among Republicans, with at least five governors saying they would  not implement the law's expansion of the Medicaid program for the poor  and handicapped.

Marilyn  Tavenner, the acting head of the Centers for Medicare and Medicaid  Services (CMS), wrote that states have no deadline for when they have to  comply with the Medicaid expansion mandated under the new law, but  should not waste "a good deal," according to a letter sent on Friday.

"We  hope that states will not turn down the resources and flexibility  offered in the Affordable Care Act (Obama healthcare law), and will put  aside old political battles to move forward with implementation," she  wrote in a letter addressed to Virginia Governor Bob McDonnell.

In  its ruling upholding the healthcare overhaul, the Supreme Court allowed  states to opt out of the expansion of Medicaid, which is jointly funded  by federal and state governments and represents the biggest spending  item in most state budgets.

The  expansion would raise the limit on annual income for eligible families,  and aims to extend health coverage to 16 million Americans.

Some  state officials are worried about a rise in Medicaid costs in the wake  of the ruling, even with the government's commitment to fund the entire  Medicaid expansion in the first three years and 90 percent of it  thereafter.

In her letter,  Tavenner was responding to concerns raised by McDonnell earlier this  week. McDonnell wrote to Obama that he was also worried about the  uncertainty surrounding the subsidized health insurance exchanges which  must be set up as part of the law to extend health coverage.

States  that decline to submit plans for their own exchange by November 16  would require the federal government to step in and operate them, but  McDonnell said it was unclear if the government will be ready or have  the funds to fully implement the law when it takes full effect in 2014.

"We  believe it is incumbent upon the authors of (the law) and your  administration to detail precisely how you intend to address this  situation," he said in the letter to Obama, which was sent on behalf of  Republican governors.

McDonnell also included 30 specific questions about the Medicaid expansion and healthcare exchanges.

So  far, 13 states have committed to establishing a state-based health  insurance exchange, according to the U.S. Department of Health and Human  Services. At the same time, 17 states have made no significant progress  towards establishing an exchange or rejected the idea, according to the  Kaiser Family Foundation, which tracks healthcare issues.

Some  health experts fear many states holding off on exchanges will wait for  the outcome of the November elections. Since building the technological  infrastructure requires time, states that wait could be ill-prepared by  the autumn of 2013 when the federal government wants the exchanges to  accept enrollment.

CMS'  Tavenner said the government was open to working with the states, and  said they could apply for federal funding to implement exchanges or  expand Medicaid. She said they would not have to pay the money back if  they ultimately decided not to participate.

"We expect that, as states study their options, they will recognize that this (law) is a good deal," she said.

A  spokesman for Virginia's McDonnell said Tavenner's letter did not  address his questions specifically, but rather said more guidance will  be issued later.

"That's exactly the problem," Jeff Caldwell, press secretary for Governor McDonnell, said in an email.

"Governors  need that 'guidance' now in order to make decisions involving  significant amounts of taxpayer dollars. We hope that this letter is  merely a precursor to a much more substantive and thorough response in  the weeks ahead."

http://reuters.com/article/2012/07/13/us-usa-healthcare-governors-idUSBRE86C0X620120713

From  the Cornfield, many states, including the Cornfield's own state, are  waiting to see what happens in November when American voters make a  decision on whether the ACA is "wise" or not. The Supreme Court in its  ruling noted that the wisdom of the ACA as written is up to voters to  decide.