ObamaCare and the States


A report in Politico suggests that state races may be a bigger factor than national races in determining how implementation of the new health care law plays out.

While congressional Republicans won't be able to repeal health care reform with Barack Obama in the White House, Republican governors and their appointees have the power to throw major roadblocks in the way of reform plans.

Governors who oppose the legislation can refuse to set up pieces of the law, such as the state-based insurance exchanges where most Americans will purchase coverage beginning in 2014. In many cases, they also can appoint insurance commissioners and Medicaid directors with directives to refuse to participate in implementing the law or the federal funding associated with it.

That's basically right. Even if they manage to nab control of the Senate in November, Republicans will still have to contend with a presidential veto and thus won't be able to repeal the law outright. A legal challenge might overturn the law at some point, but it will take a while for the various challenges to work their way through the court system (although. That means that between now and 2012, the health care policy battle is going to play out mostly through a series of politically driven policy skirmishes at the state level. Some state governments will pick fights with insurers. Others will fight back against federal dictates for the design of the exchanges and the expansion of Medicaid. Elected officials who oppose the law will have to decide whether to set up insurance marketplaces under strict administration oversight or whether to refuse and give the federal government the power to directly create some of the exchanges. It's going to be a long, drawn-out implementation squabble, and there probably won't be a clear winner. For a preview of some of the issues likely to get a lot of play, read my piece on ObamaCare and the states from the October issue.