In Races For Insurance Commissioner, GOP ‘Refuse To Participate In Any Obamacare Policies’

TIME’s Kate Pickert reports that around the country, the Republican primary for insurance commissioner has turned into a competition about who opposes the new health care law the most. And while some candidates are tripping over themselves to condemn the health care law in the harshest terms possible, they are also admitting that, if elected, they’ll have to put some of that rhetoric aside and enforce the law:

John Doak, a Republican insurance commissioner candidate in Oklahoma: “I am opposed to the President’s proposed ‘universal’ health-care plan because the federal government cannot provide adequate health insurance to Oklahomans … As insurance commissioner, I will be a conservative voice opposed to federally mandated insurance.”….

Maria Sheffield, the Georgia candidate: “I will refuse to participate in any Obamacare policies that come across my desk,” she says in one clip. “I will make sure the Obama Administration and other Big Government allies in Georgia will not, in any manner, be able to use the Department of Insurance as a vehicle to impose Obamacare on our state.”

But Sheffield admits an insurance commissioner can’t pick and choose which laws to enforce. (If a commissioner does this, the Federal Government has the authority to step in and take over enforcement responsibilities.) According to Sheffield, the difference between her and [and the other Republican candidate] is that she will keep pushing to overturn the Affordable Care Act, no matter how futile the effort might be. “If you’re not willing to lead on these issues, you’re just being a bureaucrat and not attempting to even offer solutions to people,” she says.

There are several things worth noting here. First, the gap between repeal rhetoric and reality is wide and even the staunchest opponents of reform recognize that ACA is the law of the land and that its most popular provisions are very difficult to oppose. When Pickert asked Doak “which new insurance regulations — many of which are universally popular — he opposed, Doak couldn’t answer. Does he favor a ban on lifetime coverage limits? Not sure. How about the 2014 provision that will require insurers to cover all pre-existing conditions?” “I am in favor of that, but there are many questions,” he replied. Those questions are something the national GOP is still trying to answer.

But since the law leaves implementation to the states, GOP insurance commissioners, along with some medical interests, will have plenty of opportunity to water down the bill. Insurers have historically showered state campaigns with contributions — four of the biggest health insurers contributed $8.7 million to candidates for state offices and state campaign committees in 42 states from 2005 through 2008 — and will continue to work in partnership with these new nominees (should they be elected) to weaken the bans against pre-existing conditions, rescissions and rate review. After all, if they’re not sure that they support the provisions, can we expect to enforce the rules aggressively? Probably not and I suspect the federal government will have to take advantage of all the “Secretary shall” parts of the law, step in, and ensure compliance.