Congressional Republicans appear to grasp the weight of this moment. They are doing everything they can to ensure that Obamacare never sees the year 2014: forcing votes on repealing and defunding the law, and undertaking a two-year campaign to expose its harmful effects. Unfortunately, their efforts are being undercut by their friends back home.
Rather than beat their plowshares into swords, Obamacare opponents in most state capitols are laying the bureaucratic foundations for the law’s new entitlement spending and lending it legitimacy by accepting its debt-financed federal grants. Secretary of Health and Human Services Kathleen Sebelius boasts that 48 states have already accepted at least $1 million each from the federal government to help them plan their exchanges.
It’s not just Democrats who have taken the money. Wisconsin governor Scott Walker has won plaudits for staring down government-worker unions and returning a $637,000 Obamacare grant. Yet Walker accepted a $38 million Obamacare grant to help get Wisconsin’s exchange up and running. Kansas governor Sam Brownback voted against Obamacare when he was in the U.S. Senate. Yet he has accepted a $32 million Obamacare grant and is allowing his Republican insurance commissioner, Sandy Praeger, to forge ahead with creating a Kansas exchange.
Wisconsin and Kansas are two of the 26 plaintiff states in Florida v. HHS, the case in which a federal court ruled that Obamacare is unconstitutional and void. In response to that ruling, Walker’s attorney general, J. B. Van Hollen, declared the law “dead” in Wisconsin, a reality no less true in the other plaintiff states. Yet Brownback and Walker accepted their $30 million–plus Obamacare grants after the ruling. Some governors, including Idaho Republican Butch Otter, have said that the fact that they are accepting Obamacare grants and holding exchange-planning meetings does not mean they have decided to create an exchange. But taking the money lends legitimacy to a law that Otter himself is suing to overturn as unconstitutional. To date, only two governors — Florida’s Rick Scott and Alaska’s Sean Parnell, both Republicans — have refused to accept any Obamacare money or create any Obamacare bureaucracies.
While Obamacare takes a beating in Congress, the federal courts, and the court of public opinion, why are so many opponents acting as its agents? Some state officials say they are hedging their bets. “Some legislators think the state version of the exchange is their only option, even if they don’t want it,” explains Twila Brase, president of the Minnesota-based Citizens’ Council for Health Freedom. “They think the federal exchange is an absolute certainty and that they’ll have more power over it if it’s a state-built exchange.” But that rationale rests on the false premise that Obamacare can be fixed, or its damage mitigated, if it is implemented the right way.
Obamacare confronts states with a veiled Hobson’s choice. The law provides that in 2014, each state will have its own health-insurance exchange where individuals who don’t have job-based coverage may purchase a federally regulated and subsidized (but “private”) health plan. States that develop and obtain federal approval of an exchange blueprint by 2013 may administer their own exchanges in 2014. In states that choose not to create an exchange, HHS will step in to create and administer one.
The veil is the assurance that states will be able to tailor their exchanges. Sebelius audaciously claims that Obamacare “is built on the belief that states understand their health-insurance markets better than anyone else. As such, it puts the states in the driver’s seat to lead the process.” Other supporters have sought to frighten Republican governors into implementing the law by holding out the nightmare scenario of the federal government’s administering the exchanges. Who administers the exchanges, however, is unimportant. What counts is who writes the rules that govern them. Those rules will be written entirely in Washington.