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Welcome to The Journal Editorial Report on -- go with his second term -- -- -- is president Obama's signature health care law a sure thing.
From health insurance exchanges to a vast expansion of Medicaid.
Obamacare is heavily dependent on state implementation and a growing number of the nation's thirty Republican governors.
Are saying they won't do you.
The federal government's bidding Wisconsin's Scott Walker is one of them and he joins me now governor great to have you with us.
Paul -- to be with you so when you wrote to HHS secretary Kathleen -- believes you said you weren't gonna set up next state exchange because you wouldn't have the flexibility to make it work wanted to elaborate on what you mean by lack of flexibility.
Well for all the talk.
Each of us is governors can comply with the law one of three ways -- state run exchange a partnership -- deferring to the federal government and for any.
The folks who -- allowed me to have the state run exchange they really realize -- need to realize in the end there is no real flexibility in terms of final outcome.
There is no substantive difference between each of the three options all of -- lead to federally run.
That exchange a one way or the other great example that.
He's talking over the last few weeks of my friend Gary Herbert the governor you talk right you talk cause you know probably most of your viewers know.
Years ago 56 years -- set up their own exchange they did it in a free market way they -- it working with small businesses in the state.
They have one of the lowest cost of any state in the country when it comes -- health care they still have quality health care.
But they did it -- market driven exchange.
According to my friend Gary Herbert that doesn't qualify under the the new Affordable Care Act.
And so they're gonna have to come back and put in place something that more lines and with the what the federal government wants to be answered you get all the exposure without any of the flexibility that's not a good deal.
In the behalf of the taxpayers -- my -- I said no thank you we'd rather have the federal government take on not only responsibility but the responsibility for paying for.
And that defer that to our taxes isn't there.
A risk though that if the federal government run -- the entire show that you guys will be cut out totally and that basically they will you'll have even less.
Some room for maneuver your senior year your beer companies in the state your providers in the state will really have to march entirely.
To Washington State case.
Well there is it.
At it it there's that risk but the reality is as we looked at this in fact we start looking at it literally two years ago in December of the 2010 right after the election.
I am about to the other new governors of both parties went to the White House which met in the old executive office building with secretary should -- and others they talked about flexibility event.
The reality though is the flexibility was really limited mainly.
That to things like how many staff from the state do you have do you have a handful like you -- already have hundreds like Massachusetts in terms of the regulation of what -- to be included how it's covered -- -- -- those things are all seriously dictated.
Through the federal government and and for all the talk about flexibility and it really doesn't happen I gotta tell you though as a governor who believes that federalism believes in that the tenth amendment.
-- get when given the chance and anything is to have the statement it over the federal government but.
You look at things like.
The food stamp program -- share.
You look at things like special education that's a mandate that for years has been mandated by the federal government the states and school districts -- our country.
It never comes close to covering the cost of that I think most of us who said no and deferred as I've ever did so because we didn't want the cost incurred upon our tax.
As as the law's drafted I gather that the subsidies can only flow through state exchanges that is the subsidies for individuals to have health care.
Now it's so -- the federal government delivers the exchange in your state runs it.
Then at least as drafted the -- the subsidies will not be able to flow was that part of your calculation as well on this decision.
I think in the end there's a series of things that being one of them some other things in terms of insurance regulation within -- state beyond just an exchange itself.
Those are things that we we I think all of us is governors including some Democrats.
Who who did the same thing we did and deferred to the federal government we're gonna come back to the congress work with members of both political parties I think those are reasonable.
Adjustments technical type adjustments that the congress should be of the -- going forward.
Because as you know and again your viewers know.
Most of these decisions were made just a few years ago about this time of year late in the game without any real input from governors or for that -- just about anybody else.
In these -- the technical things that if you're gonna have it at least make it work I objected to it I fought it in court I thought it politically I watched those battles I've conceded that.
I've conceded that at least for the time being they'll be -- my state to just won't be run by the state.
But I think if you're gonna make it work most people realize there has to be some technical just.
It's -- one of the things you did win on in the court case was Medicaid so now states have the option of opting out of the Medicaid expansion that is a big part of this bill.
Have you made a decision on Medicaid get -- you -- opt in or out.
I have not but I gotta tell you have much as I did about the original question I have and as do governors of both parties of real hesitations about the expansion.
In our state for example Wisconsin already has over 90% of our people cover.
We have what are the most extensive coverage systems in the country.
And so that's -- -- why we fought the bill the first place and -- you're pretty well there's a small number of people why blow the whole system for that but but having said that.
Our real concern is.
It's a 100% reimbursement for this expansion for the first three years under the -- the actual terms of the law itself if you just read it three years from now.
It drops down to 90%.
Any of us who have dealt with the federal government before and anything else and special -- was a good example again before.
Know that they come nowhere near those sorts of goals -- several years after the legislation and so.
I think many of us are concerned looking ahead to the future saying we did add massive numbers of people and Medicaid.
-- -- in more states more than others and ours it would be a relatively minimal number compared to other states it's still.
Would we be adding people and not have the funding.
And that's assuming they comply with the law in light of the fiscal cliff and everything else out there there's a very real possibility even with the next you're too.
That Medicaid funds to states might be reduced and without true flexibility through -- block grant.
We have a real tough time dealing with what we have today let alone anymore.
We -- -- now that and what's your estimate the number of people on Medicaid that you would have to -- under the expansion you know that off happier had.
Well it's very that's part of one of the the challenges with this -- -- not just on the Medicaid expansion that but even in the terms of of the of the law itself and it will we looked at the exchange.
We thought the cost of just the exchange could go up go up to as much as sixty million dollars for us that the number that would be eligible.
Fluctuates depending on what we -- do with the rest of our population and I think for a lot of governors that's also part of the concerted.
If we had a concrete answer to this it might be easier to make those decisions but.
We keep it sitting.
Questions to the administration not just for the Republican governors but for the National Governors Association -- repeatedly.
We get letters back that that really don't answer those questions that's part of the problem.
Iowa governor thanks so much being it is going to be a big debate watcher decisions carefully thanks so much for being here we will -- go Packers -- Sunday night all right I agree all right when we come back out.
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