Virginia officials who chose to remain on the sidelines and hope the Supreme Court would strike down federal health care reform must now scramble to prepare the state to meet the law's requirements.
Maryland joined many other states in opting to comply with a provision in the Patient Protection and Affordable Care Act that requires states to set up a health insurance exchange by 2013 for uninsured individuals to purchase private coverage -- or the feds would do it for them.
But Virginia Gov. Bob McDonnell ignored lawmakers and the advice of a health care task force he commissioned calling for a state exchange, choosing instead to play "wait and see."
"We've been doing some things to lay the foundation in Virginia so that if we have to comply with this monstrous mandate, that we'll find a way and do it in a way that is the least bureaucratic, and the least expensive, and the least cumbersome for the people of Virginia," McDonnell said Thursday.
Already lawmakers are preparing for a special session. House Majority Leader Kirk Cox, R-Colonial Heights, said "work will begin shortly implementing a state-run health benefits exchange."
Under Republican stewardship, Virginia has repeatedly challenged President Obama's signature domestic achievement. Attorney General Ken Cuccinelli made Virginia the first state to sue the Obama administration over the law.
Democratic-controlled Maryland, meanwhile, celebrated the law's passage. In a joint statement, Gov. Martin O'Malley and Lt. Gov. Anthony Brown applauded the ruling, "because the status quo was hurting our ability to create jobs, expand opportunity and protect the health of our children and parents."
Cuccinelli was surprisingly upbeat after the 5-4 decision was released. He praised the high court for rejecting the government argument that the Commerce Clause allowed the feds to force consumers to purchase health insurance.
"Individual liberty has been substantially preserved," Cuccinelli said.
Under the courts' ruling, states can also opt out of a new expansion of Medicaid, and Cuccinelli said Virginia should explore that option.
McDonnell wouldn't comment on that, but he did note that it will cost the state $2.2 billion over the next 10 years to add about 400,000 residents to state Medicaid rolls.
"That's going to be a vast expansion in the amount of money from the general fund, the budget, that's going to go to Medicaid, in light of all the other needs," McDonnell said.