Newly-elected Republican governors were already planning to blunt key parts of the US health care overhaul and join lawsuits against it, suggesting states could trump Congress as the hottest front in the fight over the law, The Wall Street Journal reported Friday.
Republicans recaptured at least 11 governors' seats from Democrats in Tuesday's election. Democrats reclaimed at least two seats from Republicans, in California and Hawaii.
While governors cannot avoid much of the law, they can throw sand in its gears and keep states out of involvement in a central part of it -- new exchanges for selling insurance policies.
Wisconsin's Republican governor-elect Scott Walker met with lawmakers Wednesday to discuss how to minimize the state's participation in the law's expansion of Medicaid, the federal-state insurance program for the poor.
Walker is worried that the Medicaid expansion, initially paid for by the federal government, would be too costly once states must begin paying for a portion of it in 2017.
"Free money is not free," he said in an interview. "If we can't afford it, it doesn't matter how much of it is free."
Health care companies said GOP gains at the state level offered new opportunities to influence the law's implementation.
"We have more Republican governors who may have interest in different models," Aetna's chief executive Ronald Williams told analysts in a conference call Wednesday, so the discussion "may very well tip it more toward market-based solutions as opposed to others."
Mary Fallin, a Republican elected Oklahoma governor, said she was emboldened by a largely symbolic 65 percent to 35 percent vote in her state for a measure opposing the individual insurance requirement.
"I think the people of Oklahoma have spoken that they're concerned, and they do not support the program of taking over the health care system," Fallin said, adding that she was looking at whether Oklahoma could lean on an existing public-private program that provides insurance to the poor as an alternative to the law's Medicaid expansion.
Should states opt out of the law's Medicaid expansion, they would have to remove themselves entirely from the Medicaid program -- an unlikely outcome.
But Ray Scheppach, executive director of the National Governors Association, said states were likely to press the federal government to delay the expansion beyond 2014, given states' bleak budget pictures.