Secretary Kathleen Sebelius of the Department of Health and Human Services has been “doing her best to make the Affordable Care Act — aka, Obamacare — disappear as a political liability for the president,” in the words of economics columnist Robert Samuelson.
Sebelius is trying to make Obamacare invisible by allowing the states to determine what constitutes essential healthcare. This is designed to help Democrats fight back against the charge that Obamacare is a one-size-fits-all program.
Will the ploy work? The Cato Institute’s Michael Cannon writes that one state, Michigan, has just resoundingly repudiated Obamacare (at least for now). The Michigan state house voted to return $10 million from the federal government to be used to set up health exchanges in accordance with Obamacare.
Cannon quotes Jack McHugh of the free-market-oriented Mackinac Center for Public on why the representatives voted the way they did:
Under the Michigan Constitution, no money can be spent by the state—including federal grant money—unless the Legislature passes an appropriation bill authorizing the spending…
House Republicans have shown no eagerness [to create a state Obamacare exchange], and that reluctance extended to this appropriation bill. In the colorful words of House Appropriations Chair Chuck Moss, R-Birmingham, to MIRS News, “They’d rather be caught sacrificing to Satan than voting for Obamacare, so that’s the way it is.”
Michigan is the only state to be this bold so far. Governing magazine reports that some states have “thrown up their hands” and asked the federal government to handle the exchanges, while others (even some involved in the suit against Obamacare) have moved forward.
The National Conference of State Legislatures (NCSL) estimates that 30 states and the District of Columbia have passed legislation or had an executive order to begin setting up the exchanges.
They might do better to wait a little big longer:
Joy Wilson, health policy director at NCSL, told Governing that the process of developing exchanges is defined by unanswered questions: Has HHS released enough information to create an exchange? What if the Supreme Court finds the PPACA unconstitutional? What would an exchange governing board look like? How will the exchanges be funded after federal money expires?
Yeah—about that money. It is all too easy to imagine that, if Obamacare is allowed to stand, the states will ultimately face bills that they can’t pay.