The package of health care legislation passed by the U.S. House Sunday night (March 21) would bring major changes to patients and the medical system that treats them, but it also could shake up state government in ways felt in the courtroom, on the campaign trail and in regulatory offices.
Three Republican state attorneys general — from Florida, South Carolina and Virginia — are chomping at the bit to challenge the planned changes in court. In Virginia, Attorney General Ken Cuccinelli vowed to file suit "as soon as the ink is dry" from President Obama's signature on the bills, the Washington Post reports.Cuccinelli's legal reasoning for attacking the scheme hinges on a mandate that would require individuals to buy health insurance. He says the requirement goes beyond Congress' authority to regulate interstate commerce, the rationale for federal action.
"We believe the federal law is unconstitutional as it is based on the commerce clause. Simply put, not buying insurance is not engaging in commerce," Cuccinelli said, according to the Richmond Times-Dispatch .
Henry McMaster of South Carolina and Bob McCollum of Florida, both candidates for governor this year, also promised legal action. They have been talking with attorneys general in other states about the best way to mount a challenge, according to the The State of Columbia, S.C.
"There's going to be a big free-for-all lawsuit about this," Michael Bird, legislative counsel for the National Council of State Legislatures told Reuters .
The issue is already picking up steam in races for state offices, too. In New Mexico, Republican Doug Turner promised to sue the federal government over the changes if he's elected governor, says The New Mexico Independent .
And in Massachusetts, whose own universal health system is the model for key components of the federal legislation, the federal legislation has emerged as a major theme in the governor's race, reports the Boston Herald .
"We haven't gotten it right yet, and I don't believe the Washington plan is any better than the Massachusetts plan. It may even be worse," said Treasurer Tim Cahill, a former Democrat running for governor as an independent.
In a state that altered the federal health care debate by electing Republican Scott Brown to the U.S. Senate earlier this year, the issue could become even more poignant because one of the leading Republican candidates, Charles Baker, is a former health insurance executive. Governor Deval Patrick, a Democrat, is seeking re-election.
At a policy level, the health care overhaul would affect states' role in both the public and private insurance arenas.
Of the 32 million uninsured Americans expected to get new coverage when the legislation finally goes into effect, half will be covered by Medicaid, the joint federal-state insurance program for the poor, according to The New York Times . In the House floor debate, Republicans tried to portray the bill as a massive unfunded mandate on states, even citing statements from Democratic governors.
Other insurance changes — what President Obama called "a patient's bill of rights on steroids" — would add federal regulations to what has traditionally been an issue handled by states. One of the law's provisions, for example, would require insurers to allow young adults to stay on their parents' insurance plan until age 26. But several states have already enacted similar legislation in recent years.