President Barack Obama’s re-election means his overhaul of the U.S. health-care system, opposed by most Republicans, will move ahead in all 50 states, with or without the cooperation of their governors.
State officials who held off implementing some aspects of the 2010 Affordable Care Act now face pressure to make decisions almost immediately. They have nine days to advise the federal government how they plan to manage state-run exchanges created by the law to provide medical coverage to the uninsured, or face a de facto U.S. takeover of their insurance markets.
The rest “have either explicitly said ‘no’ or have taken so few steps that you can’t really see them shifting quickly enough to play an active role,” said Alan Weil, executive director of the National Academy for State Health Policy, which assists states implementing the health law, in an interview.
“The federal government doesn’t want to run the exchange,” Keckley said in a telephone interview. “The federally run exchange was always meant as a backstop. To set up and run that federal exchange, they would have to go through the usual appropriations process in Congress. That’s a whole new battle, and I don’t think anyone in the administration is interested in that.”
“That law has so many tentacles, in terms of spending and the revenue side, that it is by default going to be impacted by a deficit reduction deal,” Tuffin said in a phone interview. “If the Obama administration is saying everything is on the table, everything can’t mean everything except the Affordable Care Act. It’s just too big.”