Obama meets with governors on healthcare

>>> as governors , we think it's important that we have a seat at the table and part of these discussions.

>> following meetings with lawmakers, ceos and middle-class families, president obama hosted a handful of governors from both sides of aisle. no doubt part of his great reasonableness tour of 2012 . six of the nine member national governors association executive committee including wisconsin's scott walker , met with the president at the white house to talk about the fiscal cliff and other issues affecting their states before coming to the mikes to address their concerns.

>> i think we all recognize that there's an impact on our states , certainly, by what happens here.

>> we want to be a part of the solution to the problems facing our nation.

>> we also are saying that states are willing to do our part. we understand it's going to be a shared sacrifice as you have to look at spending cuts. states are willing to do more with less.

>> while the national dialog is focused on the fiscal cliff which has the potential to significantly affect state budgets many governors are also tackling the implementation of obama care. starting in 2014 medicaid will be expanded to all americans within 138% of the poverty line, which is individuals making $15,000 a year or less, give health care to as many as 21 million additional americans . eight governors including one of those at the white house today, oklahoma republican governor mary fallin are rejecting the offer, concerned their states may have to foot the bill down the road. the president was sure to have some thoughts following their pow wow at the white house . the six governors are on to meet with house speaker john boehner and senate majority leader harry reid this afternoon, also sure thoughts. joy, the medicare question is really interesting in terms of how the governors play this one. in so far as, if you're a republican governor and offered the federal -- the federal government says it's going to cover i believe 100% of the cost of expanding the rolls from 2014 to 2016 and basically between 95% and 90% thereafter, to say no at this point when americans are hurting, we're coming out of a deep recession but you have 21 million people who could be offered health care , ta is a very difficult position for them to be in to say no, mostly on ideological grounds.

>> right. i think it really depends on not only how many uninsured in their states but how strong the hospital interests are and how far they're willing to go to allow hospitals to be bankrupted because they're still going to have to care for those patients. i suspect states like florida will take the money.

>> ezra , you're still with us here. state -- governering at the state level or being a republican at the state level is often very different than being a republican on capitol hill in terms of the ideological purity test . what's notable to me is, you're going to have some republican governors that are probably going to accept the expansion of the medicare rolls, and you also have republicans saying things like we need to look at shared sacrifice after meeting with the president. there is a difference when you are sort of in touch with your constituents at the state level versus someone that's sequestered in washington and subjecting yourself to gop litmus tests.

>> sometimes there is and sometimes there's rick scott in florida . it can go both ways on that. i think that what is notable is that -- and it goes to something joy said, these folks are going to get an enormous amount of pressure from their medical industries. the hospitals will be killing their governors for not accepting the medicaid portion because there's a dimension that gins to ratchet back the money that the federal government pays hospitals to cover uninsured people. we're ratcheting that back because we're going to be insure them and we're going to be insure them almost entirely at federal expense, but if you're a state like florida , say, and you refuse to take the medicaid money, it's to the just that your hospitals aren't going to get the relief from their current uninsured, they're going to get hammered on dish payments, and they're not going to like that at all. one other is quick thing i find amazing about this, if you look at a list of what states have the largest percentage of the uninsured it's mostly red. i did this a while ago, seven or eight of the ten. the top ten most insured are almost all blue. the affordable care act is a large transfer of money from blue states to red states . state like texas or florida that is relatively meager medicaid is now getting an enormous federal subsidyp. to reject a deal that good, you might be able to do that for a year or two years, while hoping to be able to run in 2016 , it's not going to go on much longer that than that.

>> rick perry has made lots of questionable decisions expanding health care coverage or you fogh the planned parenthood debate was a powerful one in that it showed how far a republican governor was willing to go to deny women basic health care coverage on ideological grounds.

>> absolutely. and i think that in fact, the medicaid expansion decision on the part of the affordable care act , supreme court decision that opened up the door to allow the governors to refuse it may make it easier for states to reject the terms that the federal government is suggesting to them. that is a whole new world. in terms of these governors standing up and saying they don't want to be part of the medicaid expansion, one thing that is troubling that you're hearing right now from health care wonks is saying that this is actually kind of sabotaging the system. it wasn't set up to have the federal government step in and do this. they were trying to give the states more control. an open question is, if these governors stay recalcitrant, are they essentially going to set the system up to fail and they get what they want.

>> that seems to be whether --

>> setting up exchanges sort of dismantle obama care or difficult to access it or ejecting the expansion, there has to be some -- the question is how much they're held accountable by their constits wents.

>> this goes to a cynicism grover referred to in his interview with you where he said well, people think that if we raise taxes on the wealthy, eventually we'll result in higher taxes for them. and part of the idea here is, people think if we can challenge this form of health care , distributed as ezra reported with very, very good mar gyps for these states -- margins from these states from the fed we can undermine the system. it's a deeply cynical view of how government benefits work and share the sacrifice. it can work in the short term because i don't know that people are super informed why they're not getting health care .

>> and ezra , as you point out, a lot of states rejecting -- that are sort of throwing the exchanges for a loop which is to say not setting up their own exchanges or denying the expansion of the medicare rolls are ones they have high rates of the uninsured. texas number one in the country with almost 25%. unfortunately we have to leave it there, my friend. but thank you for staying on with us, the " washington post 's" ezra klein . thanks as always for your insight and wisdom.

>> thank you.

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