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Medicaid decision pits governor against governor

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The Affordable Care Act, which would expand coverage to families with incomes of up to about $30,000, had directed Congress to withhold Medicaid funds from a state that did not expand the expensive program, which already can take up to a third of state spending.

In the two weeks since the court's decision, five Republican governors have opted out of expanding their states' programs and at least four more are leaning toward the same. Many more are undecided. These governors say they were caught by surprise after expecting the court to either strike down or uphold the entire law that they derisively call "Obamacare."

"We're going to make a very careful review of it and do what I think is best for the people of Pennsylvania," Governor Tom Corbett, a Republican who came into office during the party's strong showing in the 2010 elections, told Reuters on the sidelines of the conference. "The Supreme Court decision changed the dynamic."

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