The Governors were in Washington for their annual meeting of the National Governors Association. You may have seen them making the rounds on the Sunday morning talk shows.  I've seen them shuffling between meetings around town.  The annual meeting is an opportunity for state and federal leaders to meet and discuss pertinent issues.  Their focus revolves around budgetary pressures (including unions) and the impact of health care reform on their Medicaid budgets. 

With Governors from both sides of the aisle struggling with HCR implementation, The Washington Post reports that President Obama endorsed an option allowing states to opt-out of some requirements.

"I think that's a reasonable proposal. I support it," Obama told the governors who convened at the White House on Monday as part of the National Governors Association's semi-annual meetings. "It will give you more flexibility more quickly, while still guaranteeing the American people reform. If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act does - without increasing the deficit - you can implement that plan. And we'll work with you to do it."

But this is only one step in HCR implementation and does not fully address the concerns of many Governors who are facing a rising burden of Medicaid costs on their budgets.  President Obama asked Governors to partner with Health and Human Services Secretary Kathleen Sebelius to find ways to reduce Medicaid costs while covering the same population. 

While in town, Governor's Hayley Barbour (Mississippi) and Gary Herbert (Utah), both Republicans, and Deval Patrick (Massachusetts, Democrat), testified before the Energy and Commerce Committee, focusing on how the legislative mandates in HCR will hurt the states.  Focusing on the cost burden, the Republican Governor's requested more flexibility for Medicaid. 

Further complicating matters, two "dueling reports" were issued examining the financial impact on states due to HCR. The first, a bicameral report entitled Medicaid Expansion in the New Health Law: Costs to the States, from Republicans on Senate Finance and House Energy and Commerce, provides a cost estimate almost twice that of the Congressional Budget Office's score (an estimated $60 billion), estimating that Medicaid expansion would cost states $118 billion, including an additional $19.4 million in California and $27 million in Texas. In contrast, the Robert Wood Johnson Foundation (RWJF) in association with the Urban Institute, released a report entitled Health Reform Across the States: Increased Insurance Coverage and Federal Spending on the Exchanges and Medicaid. The RWJF reports that the states would receive $82.3 billion in subsidies to help defray costs.

There are still many questions left unanswered in the debate over health care reform. As policymakers continue to examine alternatives and implement provisions within the bill, we encourage them to maintain safeguards to protect patients and maintain quality of care.