States Continue To Roll Out Health Reform Law Despite Judge’s Ruling

Despite a judge on Monday ruling that the federal health reform law is unconstitutional, most U.S. states -- including the 26 involved in the lawsuit -- continue to implement its provisions, Politico reports (Kliff, Politico, 1/31).

U.S. District Court Judge Roger Vinson ruled that the law's individual mandate is unconstitutional and struck down the entire reform law on the basis that the mandate is inseparable from the rest of the overhaul (Haberkorn, Politico, 2/1).

However, all of the states that took part in the lawsuit have received some level of funding from the government to enact overhaul provisions, and states continue to move forward with implementation despite the ruling, including:

• Iowa, where the Legislature is finalizing recommendations for the best way to implement the reform law;
• Kansas, where officials wait to learn if they have secured a competitive implementation grant from HHS; and
• Texas, where a conservative state lawmaker is pushing a bill to authorize the state to start developing the infrastructure for a health insurance exchange (Politico, 1/31).

Republican state lawmakers say that while they continue to oppose the law, they are laying its groundwork to avoid ceding control of various health initiatives, such as the health insurance exchanges, to the federal government (Politico, 2/1).

Does Ruling Allow States To Opt Out of Implementation?

Some opponents of the reform law believe the ruling means that states involved in the lawsuit can opt out of implementing some of the overhaul's various provisions, such as a Medicaid expansion, CQ Today reports.

Robert Alt, an analyst for the Heritage Foundation, said Vinson's ruling essentially grants the states declaratory relief from such measures, even though the judge specifically rejected the states' argument that a mandate to expand Medicaid is unconstitutional.

Alt said, "Because the entire act was struck down, the future requirements to expand Medicaid programs will be suspended, at least as to these 26 states, and these states will be relieved of their obligation to make plans for such expansion in the immediate future." He added that the Obama administration should allow all 50 states to delay expanding Medicaid until the case is resolved.

White House officials said implementation efforts would continue by both the federal and state governments. "We don't see any basis for the opinion that somehow implementation stops," a senior White House official said (Norman, CQ Today, 1/31).