By all indications, the incoming Congressional GOP leadership will be looking to the states to provide answers to some of the nation’s most pressing questions. In the words of incoming Speaker of the House John Boehner, “Washington doesn’t have all the answers, and the best ideas usually come from outside the Beltway.“
Boehner’s comment, which came after a meeting Wednesday he jointly hosted with Senate Republican Leader Mitch McConnell with a group of newly elected GOP governors, marks the beginnings of a partnership that, say sources on Capitol Hill, people need to take very seriously.
Together, the GOP’s congressional leadership and the governors in attendance agreed to, as Boehner put it, work together to build “the same kind of strong partnership that led to the successful 1996 welfare reforms.”
What reforms this new partnership might bring about, which are separate from the expected congressional votes on Obamacare’s outright repeal, are still in development. There is a question of linkage still to be resolved: will the new GOP House, which committed in its “Pledge to America” to “repeal and replace” Obamacare wait until all the pieces of the replacement are assembled before they hold the vote on repeal?
Only time will tell. Nonetheless, the process of reform can move ahead at the state level--if the federal government allows it. In looking to the states, says healthcare expert Grace-Marie Turner, you can find examples of “pushback” already underway that are likely to influence the way that reform of the new law develops. [See editorial cartoons about healthcare reform.]
Writing for a new healthcare website, Turner cites the lawsuit already underway against Obamacare, which several of the newly-elected GOP governors have pledged to join, as one example of the emergent resistance to the new law.
Another is the resistance to the individual insurance mandate that is the cornerstone of Obamacare.
A number of states--currently 42--have either “passed or introduced Freedom of Choice legislation or amendments” that are designed to protect citizens the requirement that they either obtain government-approved health insurance or pay a penalty.
“State officials also are planning,” she says, “hundreds of hearings to learn from business people and entrepreneurs the effect on job creation and health costs of the law's new taxes and mandates.”
Then there is the issue of Medicaid, which she calls “a juggernaut that is already gobbling up resources for everything from public safety to education to transportation and it must expand under Obamacare.” Governors, she suggests, may seek more flexibility in how the program is administered so that “they can gain control over spending and be freed from federal rules,” perhaps even going as far as to seek to replicate the waiver given the state of Rhode Island by the Bush administration, which let the state get its Medicaid funding in a block grant rather than as a federal match.
They may also take the lead on requesting the flexibility to design their own Obamacare-mandated “Heath Insurance Exchanges,” which she calls “the mechanism for strict regulation of health insurance and delivery of new subsidies in 2014.”
“Many states are ready to push back against the micromanagement of a Massachusetts-style exchange and instead are looking at the much more lightly-regulated Utah Health Exchange model,” Turner says, explaining that “Utah's exchange is run by fewer than five state employees and is primarily a web-portal to facilitate the purchase of pre-tax health insurance for individuals and small businesses.”
There are other ideas out there as well. The point is that, rather than move forward with a one size does not fit all approach to health care, as Obamacare does, that the states should be free to design plans and programs that meet the needs of the residents who live there. Through these reforms and the adoption of a more flexible approach, the “replace” portion of the GOP’s healthcare promise may actually begin while the “repeal” portion is still being argued in Washington.