Since I fill up so much of this blog with news about how the states are resisting health reform, I thought it would be a good idea to point out that some states are in fact doing their very best to comply with the requirements in the new law. Thirty states have already indicated that they would be managing the temporary high-risk insurance pool program until the exchanges become operation in 2014 and others have announced that they will go further to prepare for implementation:

- California: Gov. Arnold Schwarzenegger has announced that he supports reform and will direct his administration “to begin putting the new system in place in California immediately.” The governor said he would call a special session of the Legislature, if necessary, to quickly get in place various legislative changes needed for the implementation of the federal healthcare plan.”

- Illinois: This week, the Illinois legislature “passed the Health Care Justice Implementation Act (SB3047) with bi-partisan support.” The bill will “monitor the implementation of the federal health care reforms and make recommendations per state implementation.

- Colorado: Gov. Bill Ritter “signed four bills intended to enhance the state’s role in health reform. He also issued an executive order naming a director of implementation and creating a new interagency reform task force.”

- Washington: Washington has already put in place many of the elements of the new federal health-care law, putting it closer than most states to making the federal law work for its residents. For instance, the state has high risk pools, basic health care plans and “state lawmakers already have authorized pilots for the coordinated approaches touted in federal law, including accountable care organizations.”

- Montana: “State Auditor Monica Lindeen said her office will have a new high-risk insurance pool running this summer” which will charge rates that are “equal to the cost of health insurance in the normal market.” The state is also excited about implementing the new exchanges. “We may be one of the first states in the nation to figure out exactly what our exchange looks like,” Lindeen said. “The rest of the nation will be looking at us.” “All of the market reforms really make sense,” she said.

- Minnesota: On Tuesday, the Minnesota House passed a health care bill that expands the Medicaid program and “lays the groundwork for federal health care changes.” Unfortunately, Gov. Tim Pawlenty (R-MN) has threatened to veto the measure.

As I’ve argued before, the success of health care reform will largely depend on the states. Each state is tasked with creating and administering the new health care exchanges and enforcing the new insurance regulations. The more states do now to prepare for reform, the smoother the implantation process and the greater the chance that public opinion will shift in its favor.

Republicans are fond of saying that everyone in America has access to health care, because anyone can go to an emergency room and receive treatment. “There is a misnomer out there, I think, there’s a misconception, that somehow or another… uninsured means that you have no health care,” Gov. Rick Perry (R-TX) has said. “That’s not correct. Everyone in this country has access to health care.” Similarly, Mitt Romney also makes the argument while defending reform in Massachusetts. “Everybody in America today has health care. If they get sick, even without insurance, they get free care, paid for by government. We said no more of that. No more free riders. We want people taking personal responsibility for getting health insurance if they can afford it,” he explains.

Since Gov. Jan Brewer signed the draconian immigration bill into law, however, this may be less true in Arizona than anywhere else. In fact, at least one doctor is now speaking out against the measure on medical grounds, claiming that the law could deter undocumented immigrants from seeking treatment in hospitals or free clinics, endangering their own health and the well being of the broader community.

This afternoon, during a briefing on national health disparities at the National Press Club, Dr. Winston Wong — Medical Director of community benefit at Kaiser Permanente — argued that doctors have a professional obligation to oppose any measure that endangers the care of their patients and the public’s general health. During a brief phone interview with me following the event, Wong expanded on his thinking. While focusing on the physician’s responsibility towards treating all patients fairly and equally, Wong explained that discouraging portions of the population from seeking regular medical care would harm the individual patient and also potentially facilitate the spread of communicable conditions like the flu throughout the state. It could keep the children of undocumented immigrants from receiving critical immunizations or other prenatal and preventative services that maintain the health of that individual child and the broader population.

“That this kind of policy really causes a lot of weariness among the target population around which you’re trying to launch initiatives,” Wong explained. “If you think about how we as doctors care for patients with chronic disease, it requires a long term relationship.” “We need to open up communication, we don’t need to narrow them,” he said. Wong also expressed concern that the law prevent families with mixed legal statuses from seeking medical attention, since doctors often inquire about family background when prescribing treatments. “This whole issue with regards to individuals begin fearful that their immigration status would either be identified or scrutinized, even if they are legal, really puts a barrier towards improving and maintaining clinical care,” Wong told me.

Yesterday, the Oklahoma Senate approved a ballot measure that would “allow voters to decide if the state’s constitution should forbid regulations that force people to buy health insurance.” The measure will now go to the House for final approval before appearing on the November ballot. Earlier this week, the Missouri Senate also advanced a bill that would put the individual health insurance mandate to a referendum.

Since President Obama signed health care reform into law, 22 states have filed lawsuits challenging the constitutionality of reform and at least 36 states have introduced legislation or ballot initiatives repealing all or parts of health care reform. Today, the Wonk Room, releases a map showing that 41 states are rebelling against reform in one way or another:

The states’ efforts to independently repeal the individual mandate and other provisions of reform have received far less national media attention than the lawsuits, but they’re no less important. The campaign is being orchestrated and organized by the American Legislative Exchange Council [ALEC], a “business-friendly conservative group that coordinates activity among statehouses.” The Council has generally been used as a vehicle by which large corporations advance their agenda in state legislatures and has known ties to different parts of the health care industry.

While businesses may not actually succeed in repealing the federal law — any state bill will be superseded by the federal legislation — these efforts will certainly complicate the implementation of health care care reform and play a large role in mobilizing and energizing the conservative base in the upcoming elections. Democrats and health care reform advocates have their work cut out for them.

(Map designed by Nick McClellan).

Yesterday, Tennessee Gov. Phil Bredesen (D) declined to either sign or veto a bill that prohibits health care plans participating in the state-based insurance exchange from offering “abortion services,” tacitly accepting the measure into law. Despite repeated attempts by Democrats to insert the language, the final text of the bill “makes no mention of any exception for the case of rape, incest or if the mother’s health is in danger,” as required by federal law (which provides exceptions for rape, incest and life endangerment, but not for health)

Tennessee is now the second state to officially prohibit private insurers from providing abortion coverage, even if it’s paid for out of private funds. The opt-out measure is part of a broader conservative effort, coordinated by Americans United for Life (AUL), a national anti-abortion group that released model legislation immediately after the law passed.

“Currently, 29 have either introduced an opt-out bill, are planning to introduce a bill shortly, or are laying the ground work to introduce a bill as soon as their legislative calendars permit,” AUL boasts on its website. “Some states, with our help, are going even farther than preventing insurance plans that cover abortions from participating in their state exchanges. One positive outcome from the 2009-2010 health care reform debate is that many more Americans are now aware that a large number of private insurance plans, even their own, cover elective abortions,” the group argues.

Indeed, as the Wonk Room has been reporting, states like Nebraska, Oklahoma, and Utah have used this political moment as an opportunity to foist pet restrictions on abortion, even as millions of poor women are more in need of the procedure than ever before. One such provision, vetoed by the governor but then passed again by the Oklahoma legislature, protects a doctor “from being sued if he or she chooses not to tell a woman that the baby she is carrying has a birth defect.” From HB2656:

It is the intent of the Legislature that the birth of a child does not constitute a legally recognizable injury and that it is contrary to public policy to award damages because of the birth of a child or for the rearing of that child….In a wrongful life action or a wrongful birth action, no damages may be recovered for any condition that existed at the time of a child’s birth if the claim is that the defendant’s act or omission contributed to the mother’s not having obtained an abortion.

The text of the bill is so incredibly broad and poorly worded, it gives doctors the powers to “withhold information, mislead or even blatantly lie to a pregnant woman,” if the doctor believes it would lead her to exercise her legally protected right and undergo an abortion. Women, in other words, no longer have the right in Oklahoma to know what’s happening to their bodies or their offspring, nor do they deserve to be fully informed of their medical conditions.

The bill seems reactionary even for a conservative state like Oklahoma — which may be competing for the title with Arizona — and it leads me to believe that not all lawmakers actually understood what they were voting for here. AUL has seized on the post health reform momentum to ram through abortion bills in the final days of the legislative sessions, leaving some lawmakers to rely on “assurances” and assumptions.

Lawmakers who voted for the Tennessee measure, for instance, “said they thought the bill was primarily intended to ensure that taxpayer dollars would not be used for abortion coverage in the state health insurance exchange.” In reality, the legislation goes much further. “My ‘yes’ vote was based on that it didn’t change anything in Tennessee law…and that it’s consistent with what we’ve been doing in the legislature for the past several years,” said one legislator who voted for the bill. Lawmakers also said they only voted for the bill based on assurances “that the legislation does allow for exceptions, in keeping with federal law on federal funding for abortion.”