ATLANTA — Governor Rick Scott of Florida, who made a fortune as a health care executive, long opposed President Obama’s remake of the health insurance market. But after the Democratic president won reelection, the Republican governor softened his tone.
Scott said he wanted to ‘‘have a conversation’’ with the administration about implementing the 2010 law. With a federal deadline approaching, he also said that while Florida won’t set up the exchange for individuals to buy private insurance policies, the feds can do it.
In New Jersey, Governor Chris Christie held his cards before saying he won’t set up his own exchange, but he has avoided absolute language and says he could change his mind. He is also leaving his options open to accept federal money to expand Medicaid insurance for people who aren’t covered.
The caveat, Christie says, is whether Health Secretary Kathleen Sebelius can ‘‘answer my questions’’ about its operations and expense.
Both Republican governors face reelection in states that Obama won twice, Christie in 2013 and Scott in 2014. And both will encounter well-financed Democrats.
Their apparent struggles on the issue, along with other postures by their GOP colleagues elsewhere, suggest political uncertainty for Republicans as the Affordable Care Act starts to go into effect two years after clearing Congress without a single Republican vote. The risks also are acute for governors in Democratic-leaning or swing-voting states or who know their records will be parsed should they seek the presidency in 2016 or beyond.
‘‘It’s a tough call for many Republican governors who want to do the best thing for their state but don’t want to be seen as advancing an overhaul that many Republicans continue to detest,’’ said Whit Ayers, a consultant in Virginia whose clients include Governor Bill Haslam of Tennessee, a Republican who didn’t announce his rejection of a state exchange until days before Sebelius’s Dec. 14 deadline.
Indeed, cracks keep growing in the near-unanimous Republican rejection of Obama’s health care law that characterized the GOP’s political messaging for the last two years. Five GOP-led states — Idaho, Mississippi, Nevada, New Mexico, and Utah — are pressing ahead with state insurance exchanges.
Democrats, meanwhile, hope to use the law and Republican inflexibility to their advantage, betting that more Americans will embrace the law once it expands coverage. The calculus for voters, Democrats assume, will become more about the policy and less about a polarizing president.
‘‘It shouldn’t be complicated at all,’’ said John Anzalone, an Obama pollster who assists Democrats in federal races across the country. Anzalone said Republicans could use their own states-rights argument to justify running exchanges. Instead, he said, ‘‘they are blinded by Obama-hatred rather than seeing what’s good for their citizens.’’
Governors can set up their own exchanges, partner with Sebelius’s agency, or let the federal government do it. The exchanges are set to open Jan. 1, 2014, allowing individuals and businesses to shop online for individual policies from private insurers. Low- and middle-income individuals will get federal premium subsidies calculated on a sliding income scale.
Nineteen states plus the District of Columbia, most led by Democrats, have committed to opening their own exchanges. The law also calls for raising the income threshold for Medicaid eligibility to cover people making up to 138 percent of the federal poverty line, or about $15,400 a year for an individual. That could add more than 10 million people, most of them childless adults, to the joint state-federal insurance program for low-income and disabled Americans.
Together, the exchanges and the Medicaid expansion are expected to reduce the number of uninsured by about 30 million people within the next decade.
A Supreme Court ruling last summer made the Medicaid expansion voluntary, rather than mandatory for states. At least eight governors, all of them Republicans, have said they have no plans to expand Medicaid.