Topeka With a month to go before the launch of a major portion of the Affordable Care Act, Kansas Gov. Sam Brownback remains opposed to the law—even as some other Republican governors have softened their opposition and even begrudgingly accepted the new health insurance program in their states.
In October, people without health insurance can enroll in the new health care marketplace at the healthcare.gov website for coverage that beings Jan. 1. The website is already up and providing information.
More than 320,000 Kansans will be eligible for coverage through the marketplace, the Obama administration has said. “Soon, the Health Insurance Marketplace will provide families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets,” said U.S. Department of Health and Human Services Secretary Kathleen Sebelius, the former Kansas governor.
But two years ago, Brownback rejected a $31.5 million federal grant to set up a Kansas-based marketplace under the law known as “Obamacare.”
These marketplaces in each state are modeled after travel-shopping websites and allow people to compare and enroll in insurance plans. Since Kansas refused to set up its own website, the federal government will run the marketplace for the state's residents.
In several other Republican-led states, including Ohio, Iowa, Michigan, Florida, New Mexico and Nevada, governors have dropped their opposition and allowed for the formation of the state insurance marketplaces.
The other governors' reluctant acceptance is based on what they call financial prudence and what appears to be political necessity.
"My approach is to not spend a lot of time complaining," Iowa Gov. Terry Branstad said recently. "We're going to do our level best to make it work as best we can."
That view also is embraced by fellow Republicans John Kasich of Ohio, Susana Martinez of New Mexico, Brian Sandoval of Nevada, Rick Snyder of Michigan and Rick Scott of Florida.
It's in stark contrast to the approach taken by Republicans in Washington, where the GOP-led House repeatedly has voted to repeal the law. Congressional Republicans may keep at it this fall to force a budget showdown even though the U.S. Supreme Court has upheld the law.
After initial gripes, these Republican governors are now trying to expand health insurance programs for lower- and moderate-income residents in exchange for billions in federal subsidies. Some governors are building and running online insurance exchanges for people to shop for insurance, instead of leaving the task to the federal government.
While all face re-election next fall in states that Democrat Obama won in both his White House races, these Republicans governors say that the 2014 elections and political calculations are not driving the health care decisions.
But a year after Democrats succeeded in casting Republicans as the party of the prosperous, the governors could blunt criticism they are ambivalent to the poor by embracing billions in federal dollars to cover millions of residents without insurance.
"At the end of the day they are making the best out of a crappy situation," says Phil Musser, an adviser to Martinez.
Lori Lodes of the Center for American Progress, a liberal-leaning think tank that supports the law, puts it this way: "They can't risk pursuing a partisan agenda that would turn down taxpayer dollars and deny their constituents health care."
Still, Brownback and several other Republican governors continue to hold out against implementation of the insurance exchanges and other elements of the ACA.
"Kansas Medicaid expansion, under the current ACA guidelines, would cost hundreds of millions of dollars — funding that would have to come from other core responsibilities like schools, prisons and roads," said Ren Mullinix, a spokesman for the state health agency.
Mullinix said the Brownback administration sees its overhaul of the state Medicaid system, now called KanCare, as "the best path forward."
He added, "Though HHS keeps continued interest in the innovative and forward-thinking measures taking place with KanCare, the state is not currently having discussions with HHS about expansion."
Under the ACA, states also can expand eligibility for Medicaid coverage. In Douglas County alone, it's estimated that the measure could increase coverage to as many as 11,400 of the 16,000 residents who currently don't have insurance. The federal government would pick up the entire cost of the program for the first three years and provide no less than 90 percent of the cost after that.
But Brownback and his Republican colleagues in the Kansas Legislature have rejected that offer.
The Associated Press contributed to this report.