Politico: GOP in States, Congress Approach HC Reform Differently

Double bind on health reform
By: Sarah Kliff
December 15, 2010 06:13 PM EST
Republican lawmakers on the state level are largely against the new health reform law—but they aren’t against all of the behemoth legislation.

Virginia dominated headlines this week when a federal judge ruled the individual mandate to buy insurance unconstitutional on Monday. Much less noticed: the very next day, a task force appointed by Republican Gov. Bob McDonnell recommended that the state implement a health insurance exchange earlier than federal guidelines require.

“I was pleased with the ruling. I don’t think the government can mandate you have to buy a product,” says Virginia Republican State Sen. Chris Jones. But Jones also sees the value in moving forward on implementation—he sits on the state’s health task force and is adamant Virginia run its own exchange.

“We have to be prudent and plan for implementation as it is before us today,” he tells POLITICO. “It’s the prudent thing we have to do as public servants.”

In Minnesota, outgoing Gov. Tim Pawlenty has repeatedly and vigorously opposed any participation in health reform programs, but one of his own state departments—the Management and Budget Office—is quietly receiving benefits through health reform’s Early Retiree Re-Insurance Program.

And in Alabama, Gov.-elect Robert Bentley, a Republican, said he supports Alabama creating its own health insurance exchange—a key part of the new law. He said this even as his state is party to the 20-state challenge to health reform hearing oral arguments in Florida tomorrow.

The exchanges, which will be web sites similar to Orbitz or Expedia where people can buy insurance, emphasize the GOP-friendly concepts of consumer choice and competition. Republicans are embracing them quietly even as they loudly fight other aspects of the law in federal court.

“Obviously the governors and attorney generals involved with these lawsuits are responding to the politics of this and pursuing a legislative course of action,” says Timothy Jost, a law professor at Washington and Lee University. “My experience with the state officials who are in fact implementing this is that they are civil servants in the best sense of the word. They’re government officials who understand this is the law of the land, and they do the best they can with their state.”

Republicans trumpeted the federal court ruling that struck down health reform on Monday. The judge declared the individual mandate—which requires the purchase of government-approved insurance—unconstitutional. In the closely watched suit brought by Virginia Attorney General Ken Cuccinelli, District Judge Henry Hudson found that the mandate “exceeds the constitutional boundaries of congressional power.”

"The individual mandate at the heart of Obamacare puts the federal government in the business of forcing you to buy health insurance and taxing you if you don’t. This is unwise, unaffordable, and as we have argued all along, unconstitutional," said Speaker-elect John Boehner.

But at the state level, the picture looks markedly different. In Boehner’s home state of Ohio, for instance, a health reform stakeholders forum has been meeting for months now and implementation is well underway. And all states, regardless of their politics, have accepted some form of Affordable Care Act grants, according to HealthCare.gov. Thirty-three states have taken either legislative or executive action to implement health reform, according to the National Association of State Legislatures.

“For many conservative states, there’s an anxiety that if they don’t do something it will be implemented for them by the federal government, and they’re not comfortable with that,” says Melissa Boudreault, director of Dell’s State Health Services division. Boudreault has spent months now consulting with states on reform implementation. “When we have conversations with them, they want to make this politically palatable. At the end of the day, it comes down to them saying ‘I think we’d rather control our own destiny.’”

The Obama administration expects the majority of states to participate in one of the most crucial health reform programs: the state-based health exchanges, where individuals and small groups can purchase coverage beginning in 2014. Forty-eight states applied for, and received, $1 million exchange planning grants in August. Of the two states did not apply, one will change course: Minnesota governor-elect Mark Dayton has indicated he would pursue the grant opportunity that predecessor Tim Pawlenty declined.

“We’re currently working with 48 of the 50 states who are all engaging in the process of figuring out where they want to go on exchanges,” Joel Ario, who oversees health exchanges for HHS’ Office of Consumer Information and Insurance Oversight, said on a Tuesday conference call for National Conference of State Legislators.

For their part, Republican governors walk a tightrope between preparing for the implementation of health reform while also rallying against it.

Perhaps the most striking contrast between court challenges and state implementation is in Virginia, where McDonnell has walked a tightrope, opposing health reform one day then implementing it the next.

McDonnell has been an outspoken critic of the health reform law. The day after the federal health reform law passed, he signed the Virginia Healthcare Freedom Act, the first of many state laws prohibiting the mandated purchase of health insurance. The law laid the groundwork for Cuccinelli’s legal challenge.

McDonnell came out strongly in support of the Monday Court ruling. “This decision sets the correct limits on federal power in favor of individual liberty, and supports the critical tenants of federalism enshrined in the U.S. Constitution,” the governor said in a Monday statement.

But at the same time, McDonnell has more quietly gone about the business of implementing health reform. In August he appointed a task force to the Virginia Health Reform Initaitive, which would oversee the work of implementing the federal law.

"Every Virginian needs access to affordable health care. The challenge is how to provide that access in an economically responsible manner,” McDonnell said in an August statement appointing the task force. “The make-up of these taskforces includes a wide array of expertise and opinions from across the Commonwealth. The taskforces are comprised of individuals who recognize the need for Virginia to lead the nation by establishing a responsible model for health reform and will work to the success of this initiative, both professionally and personally."

That taskforce came out Tuesday with an 85-page report advocating that the state move quickly to implement the Affordable Care Act.

“Since so many recommendations hold promise to improve quality, lower cost, or make insurance and care more affordable and accessible, opportunities for ‘early adoption’ should be prudently explored and acted upon,” the task force wrote.

© 2010 Capitol News Company, LLC

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