"Once we got the numbers, it became pretty clear that the best decision for us was to expand Medicaid," Alsop said. He later added, "The governor never said, `I don't like these numbers: go back to the drawing board.'"
In the months leading up to Tomblin's decision, Alsop fielded weekly inquiries and appeals from advocacy groups and organizations representing health care providers on the topic. These representatives appeared uniformly in favor of expansion, Alsop recalled. He said the West Virginia Hospital Association was particularly helpful by providing data. Several hospital executives appeared with Tomblin and U.S. Sen. Jay Rockefeller, D-W.Va., on Thursday to herald the Medicaid announcement.
Politics overshadowed the entire process. While Tomblin sought answers from the Obama administration and pursued the financial analysis last year, he was also running for a full term as governor. His Republican opponent, Bill Maloney, was a vocal foe of the federal health care overhaul but had at times also offered mixed statements regarding Medicaid expansion. Tomblin's fellow Democrat, President Barack Obama, was deeply unpopular in the state as he sought re-election.
"The issue of how close we were tied to the Obama administration was a huge issue in the election," Alsop said.
Tomblin noted during Thursday's announcement that his administration "may not agree with every provision" of the federal overhaul. Alsop said those areas include one limiting the range of premiums that insurance companies can charge policyholders. That language may deter young adults from buying coverage, while potentially driving up costs for those who do, Alsop said.
"There are certainly concerns about the cost and how we go about this," Alsop said. "Some of the points conservatives have raised need to be considered. On the flip side, the fact that several Republican governors have said that the scales tip in favor of expansion show that it's not a partisan political decision... We carefully weighed the pros and cons."