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.

NEXT: What Sort of Lunatic Thinks a Crime Requires a Victim?

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  1. Yes, how about a little obstructionism to show that we’re not quite dead yet?

  2. Republicans will still have to contend with a presidential veto and thus won’t be able to repeal the law outright.

    Haha, let’s all pretend they’re even going to try!

    Shit, I don’t have that much imagination.

    1. As a West Texas Republican, my Rep is pretty much guaranteed re-election. Next time he throws a town hall, I may go and ask him why he doesn’t introduce a bill that simply repeals, in its entirety, the health care reform bill.

      One sentence:

      “The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 are hereby repealed in their entirety, as are all regulations promulgated thereunder.”

      1. That sentence can, of course, be added to every single bill passed by Congress.

        Let’s make Obama veto it over and over again. Should set up his re-election campaign nicely, no?

        1. It’s such an obvious winning move for the GOP–as there’s little question that it would be a popular thing to do–that I’m sure they’ll screw up and not do it. Obama would have to commit political suicide, possibly doing major damage to the Democrats on the way, if he just kept vetoing it.

          What would really rule would be for the GOP to refuse to meet to compromise. Hell no, the bill must go!

          1. There’s a reason we call the GOP the Stupid Party.

  3. I can’t imagine why any state would want to set up an insurance exchange – they’re expensive, and they will draw the ire of consumer/voters who don’t like their health insurance.

    Well, any reason other than graft from the insurance companies, and the chance to build a new bureaucratic fiefdom, of course.

    1. The insurance companies bought and wrote this bill in the Senate via Lieberman, Nelson, Lincoln and a few others.

      30 million taxpayer subsidized mandatory customers.

      Dollars to doughnuts they have already lobbied extensive loopholes to any uninsured risks (can’t deny coverage) that the press thinks they will have.

  4. This is my first visit to this site. Is it some sort of revival of the theatre of the absurd?

    1. This is what you get when you advertise on msnbc.

    2. And you’re the star!

    3. No, the federal government provides the theatre of the absurd. This is merely a review of the current show.

      It’ll be far less entertaining when it goes all Grand Guignol on everybody. We’ll still be making snide remarks, though.

    4. Actually, the writers for this blog and all of the commenters here work for DHS.

      1. Oh, you too? How Dickian.

        1. Dick, Kafka, what’s the difference? Report to the Office of Correction.

    5. This is my first visit to this site. Is it some sort of revival of the theatre of the absurd?

      James, we’re mostly libertarians here. I, for one, have no problem with you considering your visit as some sort of revival of the theatre of the absurd.

  5. “Republicans will still have to contend with a presidential veto and thus won’t be able to repeal the law outright.”

    But they can refuse to appropriate the funds to administer the program.

    Congress controls the purse strings.

    1. Hey, you stole my premise while I was typing my long-winded post below…how un-American. Har.

  6. The Republicans in Congress have another alternative. While they cannot get over Uncle Sugar’s veto, they can definitely elect not to fund the program. As Congress is apt to do, many of the administrative costs with setting this new bureaucracy up are not funded, they need to be attached to other appropriations bills (probably the omnibus shtick and HHS budget items) as they get up and going. No dough, no bureaucracy. What’s Obama going to do if the Republicans don’t send him the cash for his schemes? He’d have to rob it from somewhere else where executive power alone can skim funds, which compared to the Chinapalooza of Congress is pretty thin pickings.

    It’s not like Obama can threaten to not sign other appropriations bills, can he? What sacred cow of the Republicans can he obstruct in exchange for Dr. Obama scratch? Maybe something like a military appropriation, or a on-going war bill, but that’s political suicide. It’s not like he can get them to jump by threatening to table ?what would it be?

  7. While congressional Republicans won’t be able to repeal health care reform with Barack Obama in the White House

    Or with a Republican in the White House, or a majority in both houses, or a dictatorship of Republicanism.

    1. Jesus could stop it, 2nd Coming and all.

  8. It will be very interesting to see how quickly those Democrats who supported medical marijuana on the ground that the states, not the feds, should determine what medical treatments are appropriate for their citizens change their tunes if Repubs at the state level oppose Obamacare on the same grounds.

    1. All you need to do to find two cases of such hypocrisy is attend any three press conferences held on Capitol Hill.

      1. Only one press conference would be enough.

  9. After November 2nd the New American Revolution will BEGIN. The States, NOT the Federal Government are Sovereign, or the People.

    It is time that the People and the States begin asserting that sovereignty.

  10. Couldn’t the GOP just propose to repeal the least popular parts of it? Put the President in a bind by making him veto the mandatory purchase of insurance provision or the overkill 1099 provision. Keep at him with the really unpopular parts and make him defend them over and over.

    1. They should do that.

      They also need to continually pound him politically on this.

      A good start is the damage it is already doing to the business community and the job market.

  11. The problem of repealing it is what will the Reps put up in its place? No one loves this bill but you still have a health care affordability problem. And instead of being an albatross on O’s neck, it will be on the Reps. This is why I agree with those who doubt this beast is going nowhere – no one has a sell-able idea to the people when it comes to health-care.

    The only thing I could come up with is that insurance companies should be required to provide coverage for catastrophic care regardless of pre-existing condition. Primary care ( check ups and self-limiting issues like colds) would be self pay. Secondary (like High Blood Pressure and Diabetes ) could have a rider option. Or you can do the reverse where insurances cover only the limited illnesses, which could mean much more early detections and possibly avoidance of a lot of illnesses. There’s one idea.

  12. repealing the monster in its entirety needs to be a fight on every front.

    November, the courts, the states, 2012 and the presidency, the media.

    It will be a long battle. But if you spend the time to understand the true implications of the bill in it’s entirety you know there is no choice but to fight.

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