While much of the discussion has been centered on Congressional reaction to healthcare reform, the real debate is likely to be shaped by the Gubernatorial elections
All of the attention during the closing weeks leading up to the mid-term elections has been focused on the Congressional races. But, there are a group of potentially successful gubernatorial candidates who could change the healthcare reform landscape even more than their Congressional colleagues. Even before the upcoming election, a small group of governors are flexing their state powers in challenges to the federal health reform law. They are exerting their powers by rejecting grants or legislative action, and it’s beginning to concern the health reform advocates. Former Majority Leader Tom Daschle in his new book, “Getting It Done” – which came out last Tuesday – noted, “The danger is that the critics of reform will kill it before it ever has a chance to take hold.” He continued, “Opponents in state government could undermine it at every turn, or simply say they cannot do what the law requires.”
While the passage of health reform kept Congress busy for the better part of a year, the actual implementation is part of the states’ responsibilities and the governors and state legislatures are drivers for actual implementation. I keep saying that the action is moving to the states, and it now has shifted. While the majority of states have applied for the initial rounds of grants, there are a couple of notable exceptions. Governor Tim Pawlenty (R-MN) – who has his eye on the 2012 Presidential elections – is taking a tough stance again implementation of the healthcare reform program. He has stopped state agencies from applying for health reform-related grants and has even prohibited them from providing public comment to the U.S. Department of Health and Human Services as it seeks input from the states prior to issuing regulations.
But, Pawlenty is not the only Governor arching his back and saying “No.” The Governors of Alaska, Wyoming, Iowa, and Georgia have also joined the fray and are refusing to seek the $1 million grants for developing state health exchange programs. Even Utah, which already has a functioning state health exchange, is expressing opposition to federal regulation of the insurance markets. So, is the groundswell turning into a minor revolution? Perhaps. Even with pressure from Democratic state legislators, the Governors from the noted states are standing firm and not moving forward – at least, at the present time.
The reason the Governors opposition is causing concern is that it could very well impact the attitude of the electorate. If people across the country do not see the results of the healthcare reform package during the next several years, and it does not have a positive impact on their lives, the electorate’s attitude – which is already shifting toward the negative – will become even more suspect of the promises made under healthcare reform.
So, it seems to me that the laboratories of democracy concept that I’ve discussed previously is in full bloom despite the fact that we are entering winter in North America. Some states are moving forward. The results of healthcare reform will become obvious during the next year or so. But those states where Governors are expressing opposition, little is likely to happen, and their constituents will not see the results of healthcare reform. The comparison of the “haves” and “have nots” will be an interesting outcome for the 2010 Presidential election, with the Governors as the ones holding the keys.
Kevin Fickenscher, MD
The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.