Resisting health-care reform, post-election edition
National Republicans have already little chance a full repeal bill could pass the Senate, much less the president's desk, indicating that the proposal is simply be a symbolic gesture to appease the conservative base that put the GOP back in power. But there are other, more impactful ways in which Republicans can resist the Affordable Care Act -- and the results of Tuesday's midterms could strengthen their ability to do so, at least on the state level.
The federal health law leaves a lot up to state governments, as I've explained before. And the midterms handed Republicans many critical wins on the state level, giving the GOP the majority of governorships (more than 30, up from 22 in 2006) and flipping at least 19 state legislative chambers, among other coups. These GOP victories are likely to shape the way that such states fulfill their responsibilities to implement critical parts of the new law. In Iowa, for instance, Gov.-elect Terry Branstad campaigned on his opposition to the federal health law, protesting the impending Medicaid expansion and individual mandate to buy insurance. While the fate of provisions like the mandate will be left up to the courts, there are more immediate ways that state officials could weaken the law.
In Iowa, as in many other states, the governor is responsible for appointing the state insurance commissioner -- the official primarily responsible for enforcing the new federal regulations of health insurers. Governors like Branstad who oppose the Affordable Care Act could be more likely to bring in officials who favor a lax regulatory regime, which would undermine the law at a critical early stage of its implementation. In Oklahoma, which directly elects its insurance commissioners, victorious Republican John Doak built his entire campaign around a vow to "repeal, replace, resist Obamacare." As such, Doak will far less likely to enforce the tough new regulations under federal law, which includes prohibitions against excessive rate increase and discrimination against those with preexisting conditions. Moreover, Doak has vowed to take his opposition to a national level, promising to persuade other members of the National Association of Insurance Commissioners to follow his lead.
To be sure, the federal government will have some ability to oversee the work of state-level regulators, allowing them to pick up the slack to a certain degree if state officials fail to step up. And some blue states, by contrast, have committed themselves to embracing the Affordable Care Act and taking steps to make it work: As Dylan Matthews points out, Democrat John Kitzhaber's victory in the Oregon governor's race is a big win for health reform. But in states that have become even less friendly toward health reform since Tuesday's GOP blowout, there will need to be even more pressure to make state officials and regulators accountable for upholding the federal law.