State Officials Could Have Significant Power Over Health Law’s Fate
Although Republicans have promised to scale back or fully repeal the federal health reform law if they regain control of Congress next month, political observers and health industry experts say state officials could hold more power over the outcome of the overhaul, Politico reports.
State officials and legislators will have the power to block the creation of state-based health insurance exchanges, according to Politico.
State officials and policymakers also can withhold funding or halt the implementation of other key aspects of the reform law, or appoint state health care officials -- like Medicaid directors -- with directives to take those actions on their behalf, Politico reports.
For example, members of the National Association of Insurance Commissioners -- which has been charged with advising HHS on the implementation of certain regulations under the law -- usually are selected by governors.
Although NAIC has made assurances that the state insurance commissioners are not involved in the politics of health reform, Politico notes that "if there's a wave of Republican governors" who are opposed to the law, "a wave of like-minded insurance commissioners could follow."
In addition, voters in several states will select new attorneys general. According to Politico, many of the Republican candidates have been campaigning on the promise to join the multistate lawsuit challenging the constitutionality of the law's individual mandate. The AGs of 20 states have signed on in support of the Florida-based lawsuit, and that number could rise to 25 next month, according to Politico.
Pawlenty a Model for Opposition
Such state-based opposition to the health reform law is modeled after Minnesota Gov. Tim Pawlenty's (R) approach to the overhaul, according to Politico.
In August, Pawlenty signed an executive order directing state officials to decline any federal funding related with the law (Haberkorn, Politico, 10/12). Pawlenty also prohibited Minnesota officials from contributing to public comments on the health exchanges.
Since then, several other governors have begun to "seriously flex their muscles" in their efforts to block the health reform law, Politico reports. Some states have declined to apply for federal grants intended to help them develop and study the benefits of the state-based exchanges.
In addition, health reform advocates have had "little success" in encouraging their states' officials to take a more active stance in the law's implementation, Politico adds (Kliff, Politico, 10/12).
Governor, Senate Candidates Discuss and Argue Health Reform
In recent days, gubernatorial candidates in Connecticut, the sitting governor in Tennessee and the Democratic candidate for a West Virginia U.S. Senate seat have discussed the health reform law. Summaries appear below.
- Connecticut: The campaign of Democratic gubernatorial candidate Dan Malloy has launched a television ad criticizing Republican opponent Tom Foley's proposals to allow insurance companies to deny coverage to people on the basis of pre-existing conditions and his stance against coverage for cancer screenings, the AP/Washington Post reports. Foley's campaign has denied the charges (Collins, AP/Washington Post, 10/11).
- Tennessee: Gov. Phil Bredesen (D) in his new book "Fresh Medicine," which is about health reform, wrote that the law is "a stunning disappointment" because it is designed on misguided legislation and falls short of accomplishing what it could have done, according to the Memphis Daily News' "TDN Blog." Bredesen, who was believed to have been on President Obama's shortlist for HHS secretary, wrote, "Reform offered a chance to clean up the baroque system we have created over the years, reduce bureaucracy, lower administrative cost and give clarity and focus to a major part of where we spend our taxpayers' money," adding, "Instead, we created more complexity, more regulations and the need for more bureaucracy" (Meek, "TDN Blog," Memphis Daily News, 10/11).
- West Virginia: Gov. Joe Manchin (D), who is challenging Republican John Raese for the state's U.S. Senate seat, expressed his opposition to the reform law during an interview on Fox News on Monday, The Hill's "Blog Briefing Room" reports. Manchin said, "The president's plan -- 'ObamaCare,' as it's been called -- is far too reaching. It's overreaching. It needs to have a lot of it repealed," adding, "If you can't fix that, repeal the whole thing" (O'Brien, "Blog Briefing Room," The Hill, 10/11).