Tomblin's spokeswoman, Amy Shuler Goodwin, rejected the notion that by not deciding on Medicaid expansion, the governor is seeking to separate himself from a president that's unpopular in West Virginia.
"The governor is asking questions to make sure he does the right thing for West Virginia, period," she said. "It's a very big decision. It's the most responsible thing he can do. That's what people expect him to do. This is going to impact a lot of people for a very long time."
Tomblin's letter to Sebelius contains 16 questions. For instance, he asked: "As a result of the Supreme Court ruling, what changes to Medicaid expansion will occur regarding exchange implementation, and when will the United States Department of Health and Human Services provide updated guidance in this regard?"
In the letter, he also asked: "Will West Virginians with incomes between 100 percent and 138 percent of the federal poverty level be eligible for cost sharing subsidies and tax credits to purchase coverage through an exchange?"
West Virginia is required to have its insurance exchange up and running by October 2013. That would include the Medicaid expansion, should the state so choose.
Perry Bryant, executive director of West Virginians for Affordable Health Care, said Tomblin is right to carefully decide on the issue. The governor should ask questions of DHHS but should also take advantage of reports that have already been written on the matter, he said.
"When I read Tomblin's letter, he seemed to be more concerned about the financial effects and not concerned with the people," Bryant said. "I think it's important to look at the costs and the benefits of expanding."
Expanding Medicaid would impact hospitals and businesses significantly, he said. Businesses pay a huge amount of the cost of treating the uninsured through "cost shift," he said. Hospitals shift the cost of treating the uninsured to those with commercial insurance, he said.
Bryant said he supports measures that allow those in West Virginia who suffer from chronic illnesses to get the treatment they need, but that does not mean the state should "blindly" expand Medicaid, he said.
"We should do it with a thorough analysis of the costs and benefits," Bryant said.
Joe Letnaunchyn, president and CEO of the West Virginia Hospital Association, said hospital officials he has spoken with are in support of the expansion, though the association's board has not met to decide on it. Letnaunchyn commended the governor for taking his time and asking questions about expansion.
"The implementation wouldn't [take place] until 2014, so there's no rush to make a decision," he said. "I think it's certainly prudent to take the time to make the decision ... I think it would be irresponsible to make a quick decision without having that information."
Reach Lori Kersey at lori.ker...@wvgazette.com or 304-348-1240.