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Va. Senate votes to outlaw individual mandates

This reads like very bad news for health-care reform:

Virginia's Democratic-controlled state Senate passed measures Monday that would make it illegal to require individuals to purchase health insurance, a direct challenge to the party's efforts in Washington to reform health care.

The bills, a top priority of Virginia's "tea party" movement, were approved 23 to 17 as five Democrats who represent swing areas of the state joined all 18 Republicans in the chamber in backing the legislation.

My vague understanding is that federal law preempts state law in these matters, but that's cold comfort. You don't want federal law to have to preempt state law in these matters. The bill is expected to make it through the House and receive the governor's signature, which is not the sort of thing that's likely to stiffen Democratic spines.

There continues to be a part of me that thinks Democrats should just send Medicare buy-in, a large Medicaid expansion, tax credits and a tax on the rich through the reconciliation process. The problem with that plan is that the interest groups would howl and fret, which means Democrats won't do it. But as things stand, Democrats are stuck defending a policy compromise that no one on the other side has agreed to, and too few on their side are excited about.

By Ezra Klein  |  February 2, 2010; 10:02 AM ET
Categories:  Health Reform  
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Next: In defense of seniors


Much like Generalissimo Francisco Franco, health care reform is still dead.

Posted by: zeppelin003 | February 2, 2010 10:05 AM | Report abuse

Yes, the Supremacy Clause of the Constitution says federal law preempts state law.

I think this development shows that we as a nation have not made the moral choice that everyone should have access to quality medical care. Once a society makes that initial decision, then there are many ways to structure a system to provide those services as our peer nations have shown. But as log as we have the "I've got mine, bub" mentality, we're not going to do the things we need to do as a community (like accept an individual insurance mandate) to make it happen.

I think this has been one of the failings of the health care debate: that the initial moral choice was never at the forefront. Instead, it's been a "what's in it for me?" debate with benefits down the road that are probable but not necessarily certain. And that's a harder argument to win in the here-and-now, especially in tough economic times.

Posted by: dasimon | February 2, 2010 10:11 AM | Report abuse

My sense is history wont reflect kindly on the first year of the Obama administration, taking on the enormous task of reforming the US healthcare system while banksters needed to be investigated, hauled before hearings and castigated, then regulated and taxed to within an inch of their existence for our safety, so we'd never again be held hostage by their stupidity, along with passing a truly massive stimulus with some kind of WPA 2010 edition should have been what 2009 was about, not healthcare reform.

Posted by: zeppelin003 | February 2, 2010 10:27 AM | Report abuse

You're finally seeing what some of us saw coming weeks ago: the imminent death of healthcare reform. And the worse thing is that Obama has sweetly and politely handed the GOP a template for defeating all of his policy initiatives. A caretaker presidency, indeed.

BTW, on the .5% chance the House passes the Senate bill with the promise of reconciliation later, could the Virginia law challenge the federal Law all the way up to the Supremes? My guess is that the Roberts court would decide in favor of Virginia, which would crack the door open for all kinds of states' nullification of federal statutes. We've seen reactionary moments in our history, but this is the most extreme in my lifetime. Canada, anyone?

Posted by: scarlota | February 2, 2010 10:41 AM | Report abuse

How does Virginia make it illegal for the federal government to tax people who don't have health insurance? Why not go all the way and prohibit progressive income taxes?

The mandates are pretty small now and intended to nudge a fairly small group of people. Can't they be restructured into something like a late entry fee for the exchanges and a cost to leave once you are in? You don't have to get insurance, but once you get this insurance, you have to keep it. If you don't get insurance, and you get sick, you can be denied on the exchanges or have to have a catastrophic plan (plus extra penalties).

Posted by: windshouter | February 2, 2010 10:44 AM | Report abuse

Wasn't there a provision in the Senate legislation that gave states a potential opt-out of the exchanges?

Even having said that, it's like we've stepped into a time machine and Jim Gilmore is Governor of the state all over again.

So many idiots.

Posted by: JPRS | February 2, 2010 10:51 AM | Report abuse

Good for my home state....they do represent the cross-section of America. For a more balanced, common sense blog, visit:

Posted by: my4653 | February 2, 2010 10:53 AM | Report abuse

'windshouter' - keep shouting in the wind until you notice something called 'politics'.

Dare not some one talks about Fed law superseding State Law since that will be the God given political opening for Tea Party.

In a sense, Ezra is way 'behind the curve' and the same vilified Rahm is actually trying to pull Obama over the Hill, beyond 2010 - 'you live today to die tomorrow'.

In our system, it seems best way is to let this wave of Tea Party (there is no other way than to describe how those VA Dem Senators supported this mandate ban) take over, expose itself and then subside. I just do not see any answers here, political answers here. The same way Karl Rove style 'paranoid about national security' style politics finally phased out; it will have to be with Tea Party as well. It will faster than the earlier cycle since contradictions in Tea Party Politics are more to bring it down itself fast.

Ezra, Dems in Congress and folks on Left have no idea that the ground beneath them has already moved. The only Dem who is aware of this seismic shift and trying to scramble something to deal with it is Obama and his White House. Seems like the only viable route is get some low hanging legislative victories under the belt to build momentum and public support and then try for HCR or even that after Nov 2010. No other way than old fashioned way.

Meanwhile, better if Ezra official declares that HCR is dead. Why is he like Cong. Dem - being coy in admitting the truth?

Posted by: umesh409 | February 2, 2010 10:59 AM | Report abuse

I seem to remember this issue being settled 145 years ago.

Posted by: redwards95 | February 2, 2010 11:00 AM | Report abuse

Ezra: "There continues to be a part of me that thinks Democrats should just send Medicare buy-in, a large Medicaid expansion, tax credits and a tax on the rich through the reconciliation process."

How about expanding insurance coverage incrementally with cost savings from the nearly 50% of health care expenditures that are already within the government's control? Let's see some proof of concepts. If Obama's reforms really can bend the cost curve in the public sector plans, then he'll be able to increase coverage without increasing taxes.

Alternately, how about redirecting public funds from other areas? Surely there are many government programs that, while desirable, are deemed less worthwhile (by Democrats) than providing health insurance to the near poor.

Posted by: tbass1 | February 2, 2010 11:25 AM | Report abuse

Conservatives have been threatening to challenge the constitutionality of an individual mandate for months now, and I remain unconvinced of the viability of such an approach. The Commerce Clause has been broadly interpreted in the past, and this kind of a plan seems to fit, from what I've read on the issue.

I am reminded of the challenges that were brought against state laws mandating seat belt use in cars (though certainly those don't raise a supremacy issue). One of the reasons for upholding those was the budgetary impact on the states in having to cover medical expenses of those injured because they weren't wearing seat belts. (I've heard similar arguments made to support greater regulation of cigarette smoking, especially bans on smoking in public places, because of the portion of the state budget that has to cover medical expenses arising from smoking or exposure to smoking).

Requiring insurance is a lot like requiring people to wear seat belts: otherwise, taxpayers pay a much higher price for covering the cost of medical treatment in ERs for the uninsured (not to mention the studies that show that once the uninsured finally seek treatment, they tend to have more serious conditions, because they haven't been regularly seeing a doctor who would catch things early on).

In short, a challenge to the mandate is going to happen, one way or another. All this VA law does is provide another vehicle, but it doesn't stregthen their chances of success.

Posted by: reach4astar2 | February 2, 2010 11:39 AM | Report abuse

The state constitution here in Arizona makes tort reform illegal, yet no one asks Republicans whether they think a federal tort reform law should preempt states' rights.

Posted by: flounder2 | February 2, 2010 11:51 AM | Report abuse

Oh gross. At one point will legislators require citizens to behave responsibly toward other citizens?

An individuals decision to purchase or not purchase health insurance has an effect on the rest of the community. Do legislators not understand how insurance works?

Posted by: ideallydc | February 2, 2010 12:01 PM | Report abuse

Such dishonest, irresponsible grand standing -- they should be ashamed of themselves. I will be writing my VA Rep and Senator (Englin and Ticer), and sure hope they did not support this nonsense and spoke out about its stupidity.

Posted by: hillgirl8024 | February 2, 2010 2:03 PM | Report abuse

They really shouldn't have sold out to pharma and the ins companies... They will be out to kill dems anyway, just like they always are (except when it's impossible to win).

Dems win on the support of liberal groups, then craft policy with the chamber of commerce types -- who are licking their chops at going after dems!

Money rules this gov.

Pass the damn bill, and let's get to having wall st write the next bill on banks.

Posted by: rat-raceparent | February 2, 2010 2:56 PM | Report abuse

1. Mandate nothing
2. Give up trying to regulate the private insurance industry. They are too powerful and Democratic senators are too gutless.
2. Let EVERYONE, employed, unemployed, self-employed, young and old, buy into Medicare IF they choose to.
3. Tax (the hell out of) the rich to subsidize medicare buy in for every family making under 120K.
4. Leave the tea baggers free to buy private insurance.
5. Let the private insurance industry reform itself by forcing it to compete with medicare.
6. Loudly let public know Democrats will not leave the poor or the middle class to the mercies of the immoral and UNREFORMABLE private insurance industry.
7. Let the Republican fight against taxing the rich.

Posted by: liberalart76 | February 2, 2010 5:28 PM | Report abuse

Ummmm. Those of you who argued that Scott Brown's election was a local phenomenon with no relevance to the national health care debate...this is yet another wake up call.

Posted by: bgmma50 | February 2, 2010 11:19 PM | Report abuse

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