NEW REPORT: How States Lose If They Push Aside Health Reform

Yesterday, Virginia became the fist state in the nation to pass a law banning “any requirement that its residents carry health insurance policies.” The legislation — which was approved by the Virginia Senate on March 8 — passed by an 80–17 vote in the Virginia House of Delegates and now goes to Governor Bob McDonnell for his signature.

Legislatures in approximately 30 states have introduced similar initiatives and Congressional Republicans have pledged to support their efforts, promising to “spend the rest of the year in the campaign to try to repeal.” I’ve previously argued that these campaigns to repeal reform are more about energizing the base and raising campaign funds than registering a serious policy disagreement. After all, Republicans had supported the individual health insurance mandate as recently as August 2009, and any successful state measure to repeal parts of health care reform will be superseded by federal legislation.

My colleague Emma Sandoe makes one additional point. She argues that if the 30 plus states considering nullification successfully pulled out of reform, they “would be left out of federal programs that would help them expand coverage for more of their residents, essentially refusing more than $28 billion a year in federal funds from the Medicaid program alone.”

Her report includes this very swanky interactive map, which calculates the number of people left uninsured because of state nullification efforts (you’ll have to go here for the interactive features):


Conservatives will argue that states like Virginia don’t need a one-size-fits all option. They should be allowed to develop their own unique solutions to the health care crisis.

But this argument obscures the fact that states don’t have the economic, political or structural capacity to invest in something as big as health care reform. State uninsured rates “vary from just under 8 percent to almost 25 percent and, generally, where those rates are the highest, the states have the least resources in terms of a tax base or population income levels to support funding for needed coverage expansions.” Political considerations, special interest influence and budgetary strains have doomed previous state-based health care reform efforts and governors who believe that nullifying federal reform is in the best interest of their citizens are placing politics ahead of sound policy.