Health Care: Washington's Way or the Highway


I haven't always been thrilled with state-level attempts to experiment with heath care policy. But as Tennesse's budget-busting Medicaid expansion showed, those experiments are easier to undo than federal policies. And even the failures can encourage small-scale policy innovation. The PPACA, in contrast, is going to force some states to give up their local policies in favor of federally-defined standardization. Case in point, Utah: Currently the state runs a streamlined health insurance exchange that state officials would like to keep. But they may be forced to scrap it in favor of a bulkier, costlier, federally approved model:

Utah is pushing HHS to allow its health exchange—a relatively bare bones purchasing portal—to serve as the federal bare minimum. The state argues that assigning the exchange too many functions would be too cumbersome for states, deterring many from participating…"We're concerned that they're not only going to want us to facilitate the purchase of health insurance, but also provide a direct venue for accessing public benefits and enforcing the mandate," Robert Spendlove, Gov. Gary Herbert's policy director, tells PULSE. "We don't know yet what they intend to require but what we would like is for Utah to be defined as the federal minimum standard."

The Utah exchange is much smaller than the country's other exchange, the Massachusetts Connector, which is an online resource for purchasing coverage. Utah's has four dedicated employees and a yearly budget of $500,000; and leaders in Utah want to keep it that way. They wrote in comments to HHS last week that the federal agency "needs to resist the temptation to expand federal authority over state exchanges so long as the functions described in federal statute are met."

State government officials are working to implement the law in many cases because they have little other option; better to go ahead with planning rather than wait for the political battles to play out before acting. But there are a number of governors and gubernatorial candidates who have been fairly vocal about their opposition to the la and their frustration with the way it's likely to affect the states.

Back in August, The Wall Street Journal reported Indiana Governor Mitch Daniels' take on the law as follows: "The bill raises almost 1,000 questions and so far they have zero answers…This is going to be a nightmare, and you would think [Health and Human Services Secretary Kathleen Sebelius'] gubernatorial experience would have given her a good intuition for that." That same month, Minnesota Governor Tim Pawlenty called the law "an intrusion by the federal government into personal health care matters and…an explosion of federal spending that does nothing to make health care more affordable."

And even Rory Reid, son of Senate Majority Leader Harry Reid and Democratic candidate for governor of Nevada, is now worrying that the law's Medicaid burden could end up negatively impacting the state's budget.

As the Galen Institute's Grace-Marie Turner told me earlier this year, when it comes to implementing the health care overhaul, states can expect to be told what to do and how to do it. "States will not be able to do it their way," she said. "They'll have to do it Washington's way."

Much more on ObamaCare and the states here.

NEXT: Nightmare on Every Street

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. states can expect to be told what to do and how to do it

    Sure, they can expect these things. But what *will* they be told? PPACA tends to kicks the can down the road to new bureaucrats. *I* expect the states will be told “Try again — we’ll know it when we see it.”

  2. Can’t the states treat this like the drug laws? They aren’t responsible for enforcing federal law. What if a state just simply refuses to set up an exchange?

    1. Order other states’ National Guard units to invade!

      1. That’s not a bad idea…

    2. “We held in New York that Congress cannot compel the states to enact or enforce a
      federal regulatory program. Today we hold that Congress cannot circumvent that
      prohibition by conscripting the state’s officers directly. The federal government
      may neither issue directives requiring the states to address particular problems, nor
      command the states’ officers, or those of their political subdivisions, to administer
      or enforce a federal regulatory program. It matters not whether policy making is
      involved, and no case by case weighing of the burdens or benefits is necessary; such
      commands are fundamentally incompatible with our constitutional system of dual
      sovereignty.” [Printz v. US, USC, 117 (1997)]

      From the case concerning the federal requirement in the Brady Bill that local officials carry out background checks.

  3. “fairly vocal about their opposition to the la”

    Personally, I prefer the “fa” or maybe the “re”.

  4. It’s for our own good, you morons.

    1. It’s for our own good, you moron.

  5. I hope the Republicans win on this matter. Obamacare is horrible. And when the dust clears I plan to tell my Republicans rep, “You know how you’ve been saying that healthcare decisions should not be made in DC? Well, theres this bill to legalize medical marijuana …”

  6. This is where I think an important Supreme Court ruling will follow in the forthcoming years after Obamacare goes into full effect. There have been cases which have sided with the states over federal takeover of power, such as Printz v. United States, Alden v. Main, United States v. Morrison, and United States v. Lopez. All of those concluded that federal authority was limited despite the commerce clause which the cases many liberals cited as legit enough to infract upon both individual, state and local authority.

  7. Sometimes local authority isn’t all it’s cracked up to be, especially when dealing with discrimination and human rights.

    IMO, people have a right not to be discriminated against based on their race, ethnicity, or their genetics. Yet, medical underwriting is mostly about doing exactly that. Many of the preexisting conditions that medical underwriting seeks to isolate are rooted in genetics.

    So if your genes made you get cancer, that’s tough luck for you, just like if your genes made you black, too bad for you. It’s a free society after all. You’ll just have to pay more than everyone else because of it.

    Sorry, but even as someone with a strong libertarian sensibility, human rights do matter. A civilized society doesn’t sort out its people for special treatment based on genetic factors. The underlying goal of PPACA has it right, and so I’ll begrudgingly accept the other nastiness that comes along with solving a problem that’s so complicated.

    In 25 or 50 years, civilized society will judge people who thought it was ok to discriminate against people with prior medical maladies as barbaric. Folks would do well to be on the right side of this argument or face the specter of looking like the anti-civil rights crowd of the 1950s, or the pro-slavery crowd of the 1960s.


  8. We’ll find out quickly when the court case in Florida is decided. ObamaCare is in trouble. Yes, we need reform and Obama means well. But we don’t need a takeover of the system.

  9. Nachdem eine Katze ist keine schlechte Sache ?berhaupt. Aber mit Allergien ist wirklich eine schlechte Sache. Und deswegen war ich von meiner Katze verlassen Denken. Ich f?hlte mich hoffnungslos. Dann h?rte ich von dieser Seite, und ich bestellte das Buch. Und nun meine Allergien sind verschwunden. Dank. Katzenallergie

  10. Ich schreibe heute, weil ich will mit dir teilen, wie man Cholesterin durch einen wissenschaftlichen Durchbruch zu reduzieren auf nat?rliche Weise. Wenn Sie diese Seite lesen, ich verspreche Ihnen, dass Sie sofort belohnt werden, und wenn Sie verstehen, will nie wieder erleben einen Tag ohne diese neue Tricks! Probieren Sie sie auf. hdl cholesterin

  11. The election is just 15 months away so I’m sure Obamacare will be hotly debated.

  12. Yes, the election will decide the future of Obamacare.

  13. definitely hit the nail on the head with the title of the post!

  14. I don’t think health care is going anywhere under Obama’s administrattion. Let’s wait an see…

Please to post comments

Comments are closed.