Subjects: Health policy
The GOP’s landslide victory in this month’s mid-term elections did more than reshape politics inside the beltway. Republicans will now govern 8 more states than they did before, and the party controls both the executive and legislative branches of government in 20 states. That was the case in just 9 states before the bloodbath.
So, how much of a threat do all those new Republican governors pose to health reform? To be sure, many of them despise the law, and made no secret about it during the campaign. The health reform law is “an intolerable expansion of federal power,” Tennessee governor-elect Bill Haslam told the Washington Post, for example. Matt Mead and Paul LePage, who are Haslam’s counterparts in Wyoming and Maine respectively, expressed similar sentiments. Many others did as well.
The Affordable Care Act’s much heralded health insurance exchanges would seem to be a likely target for these governors. The architects of the Act designed the insurance exchanges to be a place where individuals and small businesses purchase health coverage, often using federal subsidies to do so.
No governor will flat-out ignore the requirement to establish an exchange in his or her state, because the law allows the Feds to offer one of their own if they deem a state’s exchange to be inadequate. But governors can sabotage the exchanges by forcing insurers to adhere to onerous requirements such as establishing outcomes measurement systems, or providing excessively detailed justifications before enacting rate increases, for example. They can also minimize regulatory oversight of the exchanges or underfund them in various ways.
Supporters of health reform are acutely concerned about the latter possibility. “The worst-case scenario is that a state does the bare minimum and sets up an exchange in form only that’s destined to fail,” Ethan Rome, executive director of the advocacy group Health Care for America Now told the Post.Governors also have quite a bit of discretion when it comes to their state’s Medicaid programs, whose enormous expansion is a cornerstone of the law’s overarching goal to provide health insurance to 32 million Americans who don’t currently have it. Even before the expansion, Medicaid budgets were crippling the balance sheets of several states. New GOP governors are not going to raise taxes to fund the expansion, so they will likely slash payment to providers or shift enrollees into managed care plans whose tactics are perceived by many to result in denying folks appropriate care.
This sounds a bit ominous indeed, but perhaps things aren’t as bad as they seem. These governors are politicians, after all. They will do what they have to do to get re-elected. Most Americans believe to this day that citizens should have equitable access to health services, and that the catastrophic illness of a family member should not destroy that family financially. People will hold their elected officials accountable if they see them trying to deny folks access to care. And above all, people don’t want to see that their state government works as poorly as the one in Washington does. Good state politicians know this and will act accordingly.