Yet even in Texas, hollers of protest are giving way to the blunt reality of governing, as the state takes reluctant but real steps toward implementing the law. Already, Texas has developed a plan for adding Medicaid coverage for services at freestanding birth centers, an early requirement of the law. More broadly, Department of Insurance and Medicaid officials have begun working on the two biggest parts of the law for states: expanding Medicaid access and tightening regulation of insurers.
Similar scenarios are playing out across the country, where every state that’s actively challenging the law is at the same time taking steps to implement it, according to a Stateline analysis and information compiled by the National Conference of State Legislatures. Just like the states that supported the overhaul, opposition states are setting up high-risk insurance pools and setting up task forces to plan out how to meet an aggressive set of deadlines spelled out in the law. While some people see these steps as acknowledging the lawsuits’ slim chances of success, others simply see them as a smart backup plan.
I suspect that part of the reason for this dynamic is that the health care reform is actually a pretty good deal for states. Away from the cable news mics and the reelection press releases, governors stop acting like politicians and start acting like public officials. They have to realize that covering hundreds of thousands of new residents on the federal government’s dime is a cost effective strategy, particularly since it saves the states money on uncompensated care and other health expenses. The other possible factor is that unelected public officials who are responsible for dealing with the very pronounced health crisis of states like Texas and Nevada are undoubtedly pushing along the implementation process.