Republicans failed to block Obamacare in Congress. Their argument to overturn Obamacare as unconstitutional failed before the Supreme Court. They failed to elect a president to repeal the law. The drive to block or kill Obamacare failed in Congress, failed in the courts, and failed at the ballot box. Obamacare is here to stay.
Which leaves Republicans only one remaining way to scuttle the law — do everything they can to ensure that it fails. And so, many Republicans on the state level are refusing to implement it by refusing to set up exchanges — thus ensuring that the federal government sets them up instead.
Today we’ve hit a critical moment in that effort:
The vast majority of Republican-led states, faced with a Friday deadline to submit plans for running the insurance exchanges at the heart of the law, have opted instead to relinquish much or all of their control to the federal government.
Just 18 states and the District say they plan to operate their own exchanges, which are slated to begin enrollment in October. In an additional 32 states, the exchanges will be run either entirely by the federal government or a federal-state partnership.
It’s now official: In well over half of the states, local governments will relinquish all or some control over implementation of a law that will impact untold numbers of their own constituents. In so doing, they are reducing, rather than increasing, control over what happens in their own states — all in the name of states’ rights.
As Jonathan Bernstein noted recently, this kind of obstructionism may be unprecedented: Many of these officials have undertaken what looks like a deliberate effort to try to make a law that is already on the books, probably for good, work less effectively for their own constituents.
It’s unclear what kind of ramifications this will have for the law itself. States that have relinquished control may not end up determining things like how oversight of the exchanges would work, how consumers are represented and what standards to apply to health plans that will be sold on them. On the one hand, these things could have an impact on how well the exchanges work. On the other hand, as my colleague Sarah Kliff notes, experts don’t think this will ultimately prevent people from getting insurance through the exchanges, it just may slow up the process a bit. So the ultimate outcome is the same, it just may not happen quite as smoothly.
And in a way, this is exactly the point. The refusal to implement Obamacare on the state level is all about creating extra difficulties on the road to accomplishing something that will inevitably happen, anyway. Since Obamacare will inevitably become woven into the fabric of American life, just as other major progressive reforms have, the ironic outcome is that states are ceding more control to the federal government for no other reason than to appear to be doing something, anything, to resist the tyranny of Obamacare.