Groups including Americans for Prosperity -- founded and funded by billionaire conservative activists David and Charles Koch -- are lobbying governors to opt out of Medicaid expansion and avoid setting up insurance exchanges in their states, as provided under the 2009 law, Politico reported Friday.
"States can and do have the power to reject federal attempts to compel their action. Governors should use that power to tell the federal government no," AFP's state policy manager, Nicole Kaeding, said. "By creating an exchange, states will serve as de-facto administrators of the federal government implementing its rules, regulations and mandates."
States will still have exchanges, set up by the federal government. But Kaeding and Michael Cannon, a healthcare policy analyst at the Cato Institute, argue that regulators will have such a heavy hand that governors might as well leave the job to the feds.
"A state-created exchange is not a state-controlled exchange," Cannon wrote in his blog. "All exchanges will be controlled by Washington."
Some of the best-known Republican governors -- including Rick Perry of Texas, Rick Scott of Florida and Bob McDonnell of Virginia -- said well before the election they would opt out of Medicaid expansion and creation of a state insurance exchange.