States Work To Implement Health Reform Even If They Oppose It

Texas Governor Rick Perry (R)

Texas Governor Rick Perry (R)

The New York Times’ Kevin Sack has an interesting report about how states that are publicly opposing health care reform are still working to implement the measure:

In Austin, legislative hearings and agency planning sessions proceed despite Gov. Rick Perry’s vow to fight “on every front available” against a law that he characterizes as “socialism on American soil.” Bureaucrats apply for federal grants and collaborate with the Obama administration at the same time that Attorney General Greg Abbott strategizes to eviscerate the law in court.

“Sometimes it seems a little schizophrenic,” acknowledged State Representative John M. Zerwas, a Republican who favors the law’s repeal but also leads a House committee that seeks to maximize its benefits to Texas. “There are plenty of laws out there that I might not agree with. But if the law of the land says we have to do it, the last thing I want is for Texas to not be prepared or not put things in place to comply.” […]

State agency leaders said politics had not interfered to date with that task, or with new requirements to create a health insurance exchange and oversee strict regulations on health insurers.

“I don’t have any sense that I’m being held back in any way,” said Billy Millwee, the state Medicaid director.

That view was echoed by Thomas M. Suehs, the commissioner of health and human services, who said the governor “expects me to implement the federal law in the most cost-effective, efficient manner.”

Reformers have long worried that the law’s state-based implementation structure would allow red states to sabotage reform, but Sack’s piece suggests that the anti-reform states can apparently walk and chew gum at the same time.

On some level, political leaders have to appreciate the additional federal dollars the law will bring to the state (even if most of it will only last a couple of years) and protect the state’s flexibility in implementing the measure. After all, any state resistance will invite federal interference. For instance, by opting out of the interim high-risk insurance pool, Texas has already forced the federal government to implement the measure and will trigger further federal action if it fails to establish the exchanges in 2014. As one Democratic State Representative put it, “[y]ou can’t run around saying the federal government wants to take over Texas, but then when we have an opportunity to do it ourselves leave it to the federal government.” This is true enough, but one can’t shake the notion that a “schizophrenic” government — one that opposes the law publicly but is also moving forward with implementation — is not the best system for adopting such complex reforms or policing and regulating the system.