Court ruling could widen health coverage disparities among states

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WASHINGTON – President Obama, in his drive for a national healthcare overhaul, strove to provide a new guarantee that all Americans, no matter where they lived, would have basic protection against sickness and disease, ending decades of variations among states.

The Supreme Court on Thursday did not dismantle that guarantee. But even while upholding the Affordable Care Act, the court opened the door to something the president and other champions of the law sought to avoid -- widening disparities between red and blue states on who gets healthcare.

Under the court’s ruling, states will be free to decide not to cover all their poor residents through their Medicaid programs.


That may mean liberal states that have embraced the healthcare law such as California, Massachusetts and Maryland will in 2014 effectively offer all their residents health coverage, a key goal of the law Obama signed two years ago.

But conservative states such as Florida and Texas, which have refused to implement the law while they challenged it in court, could reject federal aid, leaving millions of their residents without medical insurance.

And while Republican governors will be under immense pressure to take money from the federal government for their residents, they have demonstrated a willingness over the last two years to spurn it. And political pressure is sure to remain high to obstruct further implementation of Obama’s law, which remains immensely unpopular among conservative voters nationwide.

“That could make things extremely challenging,” said Alan Weil, executive director of the National Academy for State Heath Policy.