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Bob Moon: Republicans in Congress have talked a lot about rolling back the health care reform law. And today, the White House signaled President Obama would block that, with his veto pen. But a lot of the action over the next few years will be at the state level. States have a lot of leeway in implementing the law.
And Marketplace’s Nancy Marshall-Genzer has been checking the public pulse, now that Republicans will control both the governors’ mansions and legislatures in 20 states.
Nancy Marshall Genzer: Many of the Republicans who swept into state offices pledged to fight the new health care law. Maine’s governor-elect said voters would read about him telling President Obama to “go to hell.” Now, the new GOP governors and lawmakers can’t take down the health care law. But they can be miserly with the staff and resources needed to implement it.
Alan Weil is executive director of the National Academy for State Health Policy.
Alan Weil: They’ll have the rules on the books, but they may not enforce them as actively as some other states.
Rules on setting up exchanges where people can shop for health insurance. The federal government has basic requirements for insurers who want to sell their wares on the exchanges. States can make insurers cover extra stuff, like fertility treatments. Conservative state officials prefer a free-market approach, letting most insurers into the exchanges; they think that’ll bring down prices. And speaking of price, some states require insurers to get approval for a rate hike. The free marketers don’t like that idea either.
Deborah Chollet is a health economist at Mathematica Policy Research.
Deborah Chollet: They are reluctant to become more aggressive managers of their health insurance market, or they’re simply waiting to see what happens.
What’ll eventually happen if they hold back is the federal government will step in. For example, the health care law sets some limits on premium increases. And if states refuse to set up the insurance exchanges altogether, the feds will organize and run them. States that do cooperate get rewarded with federal grants to implement the new law. Even some sitting governors who spoke out against the federal law, have applied for and taken the cash.
Len Nichols is a health economist at George Mason University.
Len Nichols: It’s one thing to campaign. It’s another thing to actually see the cold hard facts of where the money will flow.
If you can’t beat ’em, don’t just join ’em. Take their money too.
In Washington, I’m Nancy Marshall Genzer for Marketplace.
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