NCPA - National Center for Policy Analysis

Health Law's Fate Tied to State Races

October 14, 2010

Republicans have made opposition to the Democrats' health care overhaul a central theme in their push to take back Congress.  But the fate of the law may actually depend more on the outcome of dozens of state-level races across the country, says Politico.

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.

  • Kansas Sen. Sam Brownback, who is expected to defeat Democrat Tom Holland in the gubernatorial race, has promised to fight health reform "every step of the way."
  • Kansas' Republican candidate for attorney general, Derek Schmidt, has pledged to join the 20-state lawsuit challenging the constitutionality of the health law if he's elected.
  • Republican Nikki Haley has promised not just to block the law if elected governor in South Carolina but to lead a group of governors in repealing it.
  • In Pennsylvania, Republican Attorney General Tom Corbett joined the multistate suit and is now running for governor.

With the stakes so high in the states, insurers and consumer health advocates are watching these races more closely than usual, says Politico.

"Whatever happens in Washington, there will not be enough votes to override the veto the president will have," said G. William Hoagland, vice president of public policy at Cigna.  "Implementation is really being carried out at the state and local level."

The most prominent roadblocks are likely to be in setting up the exchanges.  They need to be up and running by 2014 but require so much work that health experts say states need to pass legislation establishing them next year to have them running in time.

Source: Jennifer Haberkorn, "Health Law's Fate Tied to State Races," Politico, October 12, 2010.

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