Perry and Scott say they won’t expand Medicaid, but McDonnell (center) is undecided. | AP Photos Southern govs secede from Medicaid

House Republicans are lining up to repeal the Affordable Care Act on Wednesday, but GOP governors in the South have a real plan to gut the law.

Govs. Rick Perry in Texas and Rick Scott in Florida have both said they won’t expand Medicaid to more of the working poor in their states — rejecting a central part of the law designed to cover 15 million more Americans.


( Also on POLITICO: Experts on Medicaid: Go slow)

The governors can do it because the Supreme Court ruled last month that states can opt out of the expansion without paying a penalty.

Unlike the symbolic votes in the House this week, the governors’ tough talk has real-world consequences: Texas and Florida are among five hell-no states, meaning 3 million of the potential Medicaid beneficiaries — or about 1 in 5 nationwide — won’t get coverage through President Barack Obama’s health care law, according to a POLITICO analysis of data compiled by The Urban Institute. The governors of Mississippi, Louisiana and South Carolina also have said Washington can keep its Medicaid money and the new requirements that come with it.

( Also on POLITICO: Medicaid expansion could pay off)

“The bottom line here is that Medicaid is a failed program,” Perry said in a Monday appearance on Fox News. “To expand this program is not unlike adding a thousand people to the Titanic.”

Dave Carney, a New Hampshire-based GOP operative who advised Perry for more than a decade, said that it’s a smart move for governors to come out against Obama on Medicaid because it fits with the GOP message of cutting government.

“It’s good politics because it’s good economics,” he said. “Ultimately, it's a winning argument. It's something that will go hand in hand with the rest of the campaign in terms of congressional, gubernatorial and presidential.”

But not all Republican governors are convinced and most have taken a more measured approach. The Medicaid expansion is still in doubt in at least eight other states with GOP governors who are leaning no. Among the big-state governors who still have yet to make a decision: Wisconsin’s Scott Walker, New Jersey’s Chris Christie, Virginia’s Bob McDonnell and Georgia’s Nathan Deal.

Some may join what Perry calls the “growing chorus” rejecting the expansion. The National Governors Association has a meeting in Williamsburg, Va., beginning Friday, and Perry already has been a ringleader for the anti-expansion forces. He and the other governors in that camp — Scott, Bobby Jindal of Louisiana, Phil Bryant of Mississippi and Nikki Haley of South Carolina — have discussed their positions with each other, according to a source in Perry’s camp.

Come November, all the governors will have a better idea of what the right political call was. But for now, five are out on their own.

The reluctance of other GOP governors suggests they’re not at all sure that rejecting a big infusion of Medicaid cash makes for good policy or good politics. In fact, they’re trying to recast the problem as one that Obama must solve.

In a letter sent to the president on Tuesday, McDonnell, the chairman of the Republican Governors Association, posed 30 questions to Obama about the implementation of the Medicaid expansion and the health care law’s insurance exchanges.

“While we continue to believe the best option is to fully repeal and replace the [law], states now confront numerous deadlines and face major policy decisions in the wake of the Supreme Court decision,” McDonnell wrote. “Before making any final policy decisions, governors must carefully consider the short and long-term implications of an expanded entitlement program and the consequences of significantly increasing the size of government to manage these programs.”

In contrast to the governors who raced to reject the Medicaid expansion, McDonnell raised concerns about the human pain of cutting off the Medicaid expansion in addition to the economic cost.

“If states determine that a Medicaid expansion is not in the best interests of its citizens, it is likely that there will be a significant gap in coverage for low-income individuals who do not qualify for tax credits,” he wrote.

Health and Human Services Secretary Kathleen Sebelius responded to McDonnell, saying her agency would give states “as much flexibility” as necessary to implement the law.

“I am hopeful that state leaders will take the opportunity provided to insure their poorest working families with the unusually generous federal resources while dramatically reducing the burden of uncompensated care on their hospitals and other health care providers,” Sebelius wrote.

Republican Utah Gov. Gary Herbert told POLITICO that his state won’t rush to judgment.

“I think we’re wise to kind of wait and see what the results of the November election are before we jump,” Herbert said. The election will determine “what’s going to be the face of health care reform going forward.”

The Obama administration says the expansion is a great deal for states: The federal government is funding 100 percent of the expansion for the first three years, and will eventually scale back to match $9 to every $1 spent by states. According to the Center on Budget and Policy Priorities, the federal government would pay $931 billion of the cost of the Medicaid expansion to all 50 states through 2022 — while the states would be asked to chip in $73 billion, or about 7 percent.

But governors, even some who may end up accepting the expansion, say it’s still too expensive for them. Perry said the expansion would just “enlarge a broken system that is already financially unsustainable.”

And Bryant said aside from the cost of providing coverage, the administrative costs of setting up the expansion would prove to be too much for his budget. “Simply put, Mississippi cannot afford a Medicaid expansion,” his spokesman said. However, the Centers for Medicare & Medicaid Services says it has offered help in that area — last year, it announced it would provide 90 percent of funding for states that need to overhaul their IT systems to prepare for the Medicaid expansion, separate from the funding for coverage.

Texas is second only to California in the size of its eligible populations for the expansion — without it, about 1.3 million people who were expected to get insurance through the health care law will be left uncovered. In Florida, almost a million people will find themselves without options through the law.

Jason Millman contributed to this report.

This article first appeared on POLITICO Pro at 8:10 p.m. on July 10, 2012.