Washington • Utah's members of Congress are no fans of expanding Medicaid under federal health reform, but they're trying not to pressure Gov. Gary Herbert as he considers whether to accept the program and the federal money that comes with it or join a movement of conservative states that are opting out.

A group of progressive Democrats are not as cautious, blasting a letter to each of the nation's governors in late July urging them to "refuse to play politics with people's health."

Herbert has no plans to make a decision soon, especially not before the election, where if Republicans win big they may be able to repeal the law outright.

That's what he and Utah's federal lawmakers hope will happen. They are vehemently opposed to the Affordable Care Act, which the Supreme Court has ruled is constitutional. Yet the court did make one important caveat: The federal government cannot force the states to expand their Medicaid programs, leaving each governor with a choice to make.

Seven states led by Republican governors have definitively said they will reject the expansion, while several others are leaning toward saying no, according to a survey of states by The Hill, a D.C. publication. Twelve states, all controlled by Democrats, have said yes.

The 43-member Congressional Progressive Caucus is urging governors to embrace the Medicaid expansion, which is focused on insuring low-income adults without children who are now ineligible.

Their letter says a larger Medicaid will cover millions of citizens and create jobs in the health-care industry and that governors like Herbert shouldn't wait to see if there will be a change in power before acting.

"American families have real and meaningful health care needs, and they shouldn't have to wait for any election results to hear whether their governor stands with them," said Rep. Raúl Grijalva, D-Ariz., who leads the Progressive Caucus.

Republicans are generally not big advocates of Medicaid to begin with and are skeptical of the costs of the expansion. If a state chooses to accept the expansion, Washington will fund 100 percent of the new costs for the first three years, after which federal payments gradually decline to cover 90 percent.

Herbert and Utah Republicans argue that over time it will cost the state hundreds of millions of dollars, eating up a larger portion of the state's budget.

"There's going to be time when [the states are] going to be left carrying the bag," said Sen. Orrin Hatch, R-Utah. "That's what a lot of governors are facing, and that's why they're unwilling to take on the added burden."

Hatch and the rest of Utah's Republican lawmakers have strong objections to the expansion but draw the line on giving Herbert advice, at least publicly.

"That's the nice thing about federalism, is that it delegates those kind of decisions to the states," said Rep. Rob Bishop, R-Utah. "It's not up to us congressmen to make those decisions, but I'll stand by whatever the governor decides."

Rep. Jim Matheson, D-Utah, one of the few Democrats to vote against health reform, resisted commenting on whether he supported plans to expand Medicaid, though he appreciates that the choice rests with the states.

Flexibility in health care decisions has been a mantra for Herbert, who recently wrote an op-ed for The Washington Times, in which he argues for less government control.

"Give me less money and no strings and I'll deliver better services," he said.

Herbert and his staff are exploring their options, meeting with interested parties, including people from the insurance industry, the hospitals and nonprofit groups as he weighs the implications.

If he accepts the expansion, 139,000 uninsured adults would be eligible to join Medicaid. If he decides to reject the expansion, it would result in the federal government giving health care subsidies to a portion of that group so they could purchase insurance through an online exchange when the law is fully implemented in 2014, though a portion would remain uninsured.

arivera@sltrib.comTwitter: @AndreasCRivera —

Big decision

Governors must decide if they will accept or reject the Medicaid expansion under the Affordable Care Act. So far, a group of Democratic governors have said yes and Republicans have said no. Most states, including Utah, haven't weighed in yet.

States accepting the expansion

California

Connecticut

Hawaii

Illinois

Massachusetts

Minnesota

Maryland

New York

Oregon

Rhode Island

Vermont

Washington

States rejecting the expansion

Florida

Iowa

Kansas

Louisiana

Nebraska

South Carolina

Wisconsin

Source: The Hill newspaper