What happens if governors ignore health-care reform?
It's worth noting that the threat in Indiana Gov. Mitch Daniels's op-ed is that governors such as he won't lift a finger to implement the health-insurance exchanges. But it's important to note, as Sam Stein does, that if governors walk away from implementation, the bill empowers the feds to simply implement the law themselves:
"For a lot of things there is a federal backstop," explained one administration official. "States have the first crack at it, for the lack of a better phrase, and states are empowered to take the lead on things, that's what we wanted. . . . But at the same time we aren't going to allow someone not to get important consumer protections just because he has the misfortune of living in a state that doesn't like the law."
The threat of federal intervention is more motivating than any other card the administration has or can play, and it is felt most acutely with respect to the state-based exchanges, which are required to be operational by 2014.
Len Nichols, a health care policy expert with George Mason University, has consulted a number of state governments on implementing reform. And when he looks at how governors are handling the federal grants coming their way, he offers a simple set of questions:
"Are you confident you can beat Barack Obama in 2012? If the answer is no, and you say, 'I don't want to do reform and bet I can beat him,' if you lose, then Kathleen Sebelius will set up your exchange. Who wants that? No one. Not even Massachusetts."
| February 8, 2011; 12:07 PM ET
Categories: Health Reform
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