The Supreme Court's closely-watched 5-4 decision upholding the Affordable Care Act, the Obama administration's signature health care reform initiative, has sent shock waves through state legislatures that will carry it out.
The fallout from the ruling will be especially interesting to watch in Southern states, which have some of the highest rates of uninsured people -- as well as lawmakers who have been some of the Act's most vociferous critics.
Here's a survey of where Southern states stand and the reaction of state lawmakers and candidates (source unless otherwise noted is Associated Press):
- Number of uninsured:
- 720,000 state residents are uninsured, or about 15.4 percent.
- Where Alabama stood before Supreme Court decision:
- Republican Gov. Robert Bentley created a commission in 2011 to recommend a plan for a health insurance exchange, but he successfully opposed efforts to enact one in May. Critics said the bill would have limited the exchange to companies operating statewide.
- Reaction to Supreme Court ruling:
- Statement from Gov. Robert Bentley:
I am deeply disappointed by today's Supreme Court decision. The health care law is an overreach by the federal government that creates more regulation, bureaucracy, and a dramatic increase in costs to taxpayers ... The ACA is the single worst piece of legislation to come out of Congress. This law must be repealed. People need more choices, not fewer choices. Bigger government is not the answer. Market-based solutions are the best solutions to giving the public the most affordable options.
Number of uninsured: 539,000 state residents are uninsured, or about 19 percent.
Where Arkansas stood before Supreme Court decision: Arkansas opted for a federal-state partnership for its health insurance marketplace. Legislators blocked a bill by which the state would have created its own insurance exchange but have since accepted a grant that will allow it to at least have a role in the federally created exchange.
Reaction to Supreme Court ruling: Statement from Gov. Mike Bebe (D):
We will study the impact the Court's ruling will have on health care in Arkansas going forward. In the mean time, our separate initiative to create cost savings and improve health care in Arkansas continues. Our aim is to set an example other states can follow, regardless of what transpires next in Washington, D.C.
Reactions of other Arkansas lawmakers here.
Number of uninsured: 3.85 million Floridians are uninsured, or about 21 percent.
Where state stood before Supreme Court decision: On Republican Gov. Rick Scott's orders, Florida rejected or declined to pursue more than $106 million of money for implementing the law and has returned $4.5 million. That state has its own health insurance exchanges, but without an individual mandate, and has not implemented an exchage that would meet the requirements of the Affordable Care Act.
Reaction to Supreme Court ruling: Gov. Scott has reportedly declined to comment on the decision, saying "I need to review it first." Florida's Republican Attorney General Pam Bondi said she was "surprised, shocked."
Number of uninsured: 1,905,000 state residents are uninsured, or 19 percent.
Where state stood before Supreme Court decision: Georgia has taken no action to implement a health care exchange, and various bills to allow or hinder the state's carrying out of the bill have failed to pass.
Number of uninsured: 640,000 state residents are uninsured, or about 15 percent.
Where Kentucky stood before Supreme Court decision: Kentucky began process of creating statewide health insurance exchange, but Democratic Gov. Steve Beshear was waiting for Supreme Court ruling before moving forward.
Reaction to Supreme Court ruling: No formal statement yet from the governor. U.S. Senate Minority Leader Mitch McConnell (R-KY) said the court's decision was a "road to repeal."
Number of uninsured: 886,000 state residents are uninsured, or about 20 percent.
Where Louisiana stood before Supreme Court decision: Both Republican Gov. Bobby Jindal and Attorney General Buddy Caldwell (R) are on record in opposition to the law, and Louisiana is one of the states challenging it in court.
Reaction to Supreme Court ruling: Statement from Gov. Jindal:
Ironically, the Supreme Court has decided to be far more honest about Obamacare than Obama was. They rightly have called it a tax. Today's decision is a blow to our freedoms. The Court should have protected our constitutional freedoms, but remember, it was the President that forced this law on us.
The American people did not want or approve of Obamacare then, and they do not now. Americans oppose it because it will decrease the quality of health care in America, raise taxes, cut Medicare, and break the bank. All of this is still true. Republicans must drive hard toward repeal, this is no time to go weak in the knees.
Number of uninsured: 618,000 state residents are uninsured, or about 21 percent.
Where Mississippi stood before Supreme Court decision: Former Republican Gov. Haley Barbour had originally proposed a state exchange; GOP Mississippi Insurance Commissioner Make Chaney has accepted federal money for setting one up.
Response to Supreme Court decision: No formal statement from Gov. Phil Bryant yet. Lt. Gov. Tate Reeves, however, was unhappy:
I am extremely disappointed by the decision. However, the Supreme Court has stated plainly what the President and his allies went to great lengths to deny: Obamacare is a tax. In fact, it is a massive tax hike on the American people. Obamacare was bad law yesterday and it’s still bad law today.
Before the ruling, insurance commissioner Chaney reiterated his support for the law, saying "It would create some real instaibility in the market" if the clause requiring coverage of pre-existing conditions was voted down, and saying the state planned to move ahead in creating an exchange whatever the Supreme Court's ruling.
Number of uninsured: 1.57 million state residents are uninsured, or about 17 percent.
Where North Carolina stood before Supreme Court decision: Republicans introduced legislation to prohibit the Act's individual mandate, but they haven't been able to overcome exiting Democratic Gov. Beverly Perdue's veto.
Reaction to Supreme Court ruling: No word yet from Gov. Perdue, but Republican gubernatorial hopeful Pat McCrory said in a Tweet that: "Today's decision by the Supreme Court is disappointing and upholds a law that I believe is the wrong approach for the people of NC."
Number of uninsured: 930,000 state residents are uninsured, or more than 20 percent.
Where South Carolina stood before Supreme Court decision: South Carolina is among states that sued over the constitutionality of the law, and has not taken any steps to implement exchanges.
Reaction to Supreme Court ruling: Republican Gov. Nikky Haley said "how we take care of South Carolinians ... is not the way they take care of Texans, it's not the way they take care of Californians. If D.C. would let us do our job, we would spend less money." Other reactions here.
Number of uninsured: 930,000 people are uninsured, or about 15 percent.
Where Tennessee stood before Supreme Court decision: Tennessee began creating a health insurance exchange, but will have to wait until legislature returns in 2013 to complete the process.
Reaction to Supreme Court ruling: Gov. Bill Haslam (R) stated:
We will review the entire Supreme Court’s opinion to fully understand its impact on the State of Tennessee. From initial reports, it appears the individual mandate has been ruled Constitutional and has been upheld.
My primary issues with ObamaCare are that it takes away the flexibility for states to encourage healthy behavior, will cost Tennessee hundreds of millions of dollars, and does nothing to solve the crisis of the cost of health care in America.
Haslam ended with a partisan rallying cry: "Now it is up to Tennesseans and Americans to turn their attention to the November election. By electing Mitt Romney, we can be sure that the entire law will be repealed."
Number of uninsured: About 6.2 million, or about 25 percent
Where Texas stood before Supreme Court decision: Gov. Rick Perry (R) and Texas have vehemently opposed the law, joining the lawsuit against it and declining to implement a health care exchange.
Reaction to Supreme Court ruling: Gov. Perry said the ruling "will be a stomach punch to the American economy" and called it "a shocking disappointment to freedom-loving Americans desperate to get our country back on track." His statement further said:
Obamacare is bad for the economy, bad for health care, bad for freedom. Americans have made clear their overwhelming opposition to its convoluted, burdensome and overreaching mandates ... Freedom was frontally attacked by passage of this monstrosity – and the Court utterly failed in its duty to uphold the Constitutional limits placed on Washington,” Perry said. “Now that the Supreme Court has abandoned us, we citizens must take action at every level of government and demand real reform, done with respect for our Constitution and our liberty.
Texas Attorney General Greg Abbott (R) was much less pessimistic, calling the ruling "an historic victory for individual liberty, states' rights, and limited government."
Number of uninsured: 1.1 million state residents are uninsured, or about 14 percent.
Where Virginia stood before Supreme Court decision: Virginia officials have stated that they intend to create a health care exchange, but Republican Gov. Bob McDonnell has not acted on recommendations from an advisory council.
Reaction to Supreme Court ruling: Gov. McDonnell called the decision "a bad ruling for the American people." Attorney General Ken Cuccinelli (R), the first state attorney general to file suit over the law, was even more bleak:
This is a dark day for the American people, the Constitution, and the rule of law. This is a dark day for American liberty.
More Virginia reactions here.
Number of uninsured: 244,000 state residents are uninsured, or about 13.5 percent.
Where West Virginia stood before Supreme Court decision: West Virginia had enacted legislation allowing for a state-run health care exchange, but was waiting for Supreme Court decision before setting it up.
Reaction to Supreme Court ruling: Statements still being collected.*
Stay tuned for further updates.
* An earlier version of this story mid-identified the governor of West Virginia, Gov. Earl Ray Tomblin.