July 12--CHARLESTON, W.Va. -- Gov. Earl Ray Tomblin has yet to decide if the state will join a federal effort to extend health insurance to thousands of low-income West Virginians, the state's top Medicaid official said Wednesday.

At the same time, Tomblin's Republican opponent is attempting to pressure Tomblin to take a position on health care reform even as the U.S. House on Wednesday made a second futile effort to repeal the whole law.

In the meantime, West Virginia policymakers remain in limbo about key elements of the health care reform effort. These complicated policies are supposed to be in place by January 2014.

During a meeting of policymakers in Charleston, the head of the state Medicaid program, Nancy Atkins, said state officials had more questions than answers following last month's U.S. Supreme Court ruling.

While the court upheld the bulk of the law, it also ruled states could opt out of a federal plan meant to expand Medicaid. The expansion effort was meant to provide insurance to 16 million low-income Americans, including about 130,000 West Virginians.

Tomblin has yet to say whether he wants to expand Medicaid.

Asked when Tomblin would talk to people about health care reform, Atkins told the group of policymakers, "That's a good question."

Tomblin's spokeswoman did not comment on Wednesday.

In the meantime, Atkins said state officials were trying to be ready if Tomblin gave the green light to expand Medicaid.

"We are just moving forward because there's so much foundational work we have to do until we make a decision," Atkins said.

Medicaid currently insures about 420,000 West Virginians making up to about 30 percent of the federal poverty level.

The federal health care reform law was meant to expand the number of people eligible to 133 percent of the poverty level and do more to include poor but childless adults. Congress wanted the expansion to be virtually mandatory for states, but the Supreme Court ruled it was optional.

Now states have a choice.

The choice is easy at first. The federal government will pick up the entire tab in the first few years. But, after 2020, states have to pay 10 percent of the bill.

That's a small portion, but West Virginia's tab is estimated to be about $80 million a year, although there have been no recent or detailed estimates.

Supporters argue the state would save tens of millions more than that by improving people's health and reducing the amount of charity care hospitals provide to the uninsured.

Renate Poore, who works for two state think tanks that support the Medicaid expansion, said studies show the state would save money.

Poore also wondered why some politicians and conservative commentators opposed efforts to spend more state money to get more federal matching money. State and federal spending on highway projects works basically the same way as the Medicaid expansion, she argued. Yet most politicians are more than willing to attend ribbon cuttings for new bridges built with federal money.

"We take all the federal dollars we can when it comes to highway spending; why wouldn't we do the same for health care?" Poore wrote in a letter she read from during the meeting.

For now, Tomblin's political and policy approach toward the health care reform law -- which Republicans are trying to use against Tomblin and other Democrats -- is unknown.

Tomblin, for instance, has so far declined to appoint members to a board that will oversee a so-called insurance exchange, which is basically a government-created marketplace for insurance.

Tomblin signed the law that created the board. A spokeswoman said earlier this year he was awaiting the Supreme Court ruling to appoint members to the board.

Jeremiah Samples, an official with the West Virginia Offices of the Insurance Commissioner, said Wednesday the fate of the board was "being deliberated upon by the Governor's Office."

But a bigger question is whether to expand Medicaid.

Atkins, who had just returned from a trip to Washington to talk to federal health care officials, said there were a lot of questions about the health care ruling.

"You get four attorneys in the room, you get four different opinions," she said.

Based on her comments, it appears the state is trying to figure out if it can expand Medicaid cheaply.

While the federal law was intended to expand Medicaid to everyone making 133 percent of the poverty level, Atkins suggested the state was looking at whether it could enroll fewer people.

But there are some questions about how that might work and whether that is even legal.

Likewise, the federal law may somehow tie the hands of states that try to make changes to their existing Medicaid programs to free up money to pay for the expansion.

Atkins said officials were still trying to understand that, too.

It's unclear how much of Tomblin's silence is attributable to doubt about weighty policy decisions or to politics.

Republican Bill Maloney, who is challenging Tomblin in this fall's election, has been taunting Tomblin to take a stand. Maloney said he supports a full repeal of the law.

The U.S. House on Wednesday voted to do just that. The vote was the second time the Republican-majority House had voted to repeal the health care reform law. But their effort got nowhere last time. And, again, the Democrat-majority Senate will not move the bill and the president will not sign it.

The repeal effort cleared the House in a 244-185 vote that was mostly along party lines. Five Democrats voted for repeal. No Republicans voted against repeal.

Reps. Shelley Moore Capito and David McKinley, R-W.Va., both voted to repeal the health care reform law.

"The health care law represents a massive tax increase on middle class Americans," McKinley said in a statement.

Rep. Nick Rahall, D-W.Va., voted to keep the law in place.

"While improvements can certainly be made to the law, wholesale repeal would unquestionably be to the detriment of West Virginia," Rahall said in a statement.

Contact writer Ry Rivard at ry.rivard@dailymail.com or 304-348-1796. Follow him at www.twitter.com/ryrivard.

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(c)2012 the Charleston Daily Mail (Charleston, W.Va.)

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