In GOP-led states, health-care law inspires attacks and accommodations

At 42, Virginia's Ken Cuccinelli stands as one of the most high-profile, active attorneys general in the state's history.
Washington Post Staff Writers
Monday, February 21, 2011; 10:14 PM

With battles over the president's signature health legislation underway in the courts and on Capitol Hill, a third line of attack is forming in the states: Practically every week, a Republican governor or lawmaker announces a new effort to kill the health-care law or undercut its implementation.

Some have returned federal funding to prepare for the rollout and halted early planning work. But others are moving forward even as they pursue efforts to overturn the law.

GOP-led states are staking out different approaches because, for all the tough talk of opposing the law, their room to maneuver is finite.

They are attacking a law whose major provisions do not take effect until 2014, which means that for now, there is not much to obstruct.

Meanwhile, because significant Republican wins in November 2012 could lead to amendments or outright repeal, GOP governors have an interest in trying to undermine voters' confidence in the law by vowing to oppose it.

Yet if the law survives the aftermath of the 2012 election - and the court challenges - the governors will have an incentive to implement it themselves. That's because the law empowers the federal government to step in where states fail to take the lead.

For instance, Republican governors would face a choice between letting a Democratic administration establish a potentially more regulated version of state-based private insurance markets known as "exchanges" or designing their own.

And if these governors don't start laying the groundwork soon - deciding what new rules to issue and agencies to revamp - they risk missing the Jan. 1, 2013, deadline by which states must prove they have made enough progress to avoid a federal takeover.

So it's not inconsistent for many Republican governors to be simultaneously opposing the law and instructing state agencies to begin setting its provisions in motion, said Alan Weil, executive director of the National Academy for State Health Policy.

"They are just expressing the two parts of their job," he said. "Governors are both political leaders who advocate for positions and the chief executive . . . who [has] to make things work."

The dynamic helps explain the range of tactics GOP state leaders are employing:

Declared dead

After a federal judge in Florida not only struck down the health-care law but suggested that his judgment was the "functional equivalent of an injunction," officials in three of the 26 states party to the suit - Alaska, Florida and Wisconsin - declared the law "dead."

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