I know it makes for great media to focus on repeal, or the constitutionality of the mandate, or whether attempts to defund the law will bring about a government shutdown. But those fights are mostly theater. This is how health care reform could die:
The Obama administration issued far-reaching rules Monday to carry out a controversial promise that the new health-care law makes to consumers: insurers must spend at least $4 out of $5 they collect through premiums on direct medical services and other means to improve Americans’ health…
At the same time, the regulations make a few concessions to the insurance industry. The administration has given new and small health plans extra time to meet the standards. Insurers will be allowed to deduct most of their taxes before doing the math. And states may ask for federal permission to exempt from the rules health plans sold to individuals – a relatively small but expensive and shaky part of the insurance market – if they can prove that meeting the requirements would prompt such plans to stop doing business within the state.
I keep arguing that the focus needs to be more on the states. This is one of the reasons why.
Let’s review once more. Most of the uninsured are going to be getting their insurance through the exchanges (or Medicaid). Those are implemented at the state level. State level insurance decisions are made by state insurance commissioners, who are appointed by governors. Other rules may be set by state legislatures. And many states are far more conservative than the federal government. In fact, Republicans control 29 states after the last election.
So an insurance commissioner who does not like the ACA could try and force HHS to remove the restrictions and regulations they don’t like – legitimately. There will certainly be times in the future when the White House, and therefore HHS, will be controlled by parties that don’t care for reform. And they can – according to the law itself – allow states to roll back the regulations.
Health care reform won’t die by repeal. It will die slowly, by a thousand cuts. But I guess that doesn’t work for the 24-hour news cycle.
