When Speaker Pelosi announced passage of the Affordable Health Care for America Act (H.R. 3962), Democrats in the House of Representatives erupted in cheers and high fives.
Across the aisle, the Republicans watched glumly.
Afterwards, the Democratic and Republican House Leaders made predictable claims about H.R. 3962.
John Dingell (D- Michigan), the Act’s sponsor, trumpeted its passage by declaring that the “House Makes History on Health Reform: For the first time in U.S. history, the House votes to provide quality, affordable health insurance for all Americans.”
John Boehner(R-Ohio), the House Minority Leader, warned that “Speaker Pelosi’s Government Takeover of Health Care Will “Dim the Light of Freedom.”
In all this tumult and shouting, little has been said about the impact of the proposed health care reforms upon the 50 states. This might be one of the most contentious and divisive issues in reforming America’s health care system.
Implementing any enacted health care reform (H.R. 3962, S. 1796 or a conciliatory measure) will be costly to the states. Nearly everybody agrees.
The Congressional Budget Office(CBO) has a $39 billion increase in state spending over the next ten years as a consequence of implementing H.R. 3692. This projection is based upon mandated changes in state laws governing Medicaid and Children’s Health Insurance Program (CHIP) enrollment requirements. An unforeseen number of working poor might also be added to these rolls, because they will be unable to either purchase the required health insurance or pay the fine for not having insurance(Reuters).
The Reuters’ analysis of H.R. 3692 indicates still further costs to the states. Several states anticipate allocating millions of dollars for the technology needed to administer the proposed health-care exchange system.
With Medicaid expenditures and state budgets currently headed toward a fiscal precipice ( Download 8001), what are the states to do about the forecasted H.R. 3962-related costs?
Raise taxes? Not a good option for state officials who want to remain in office.
Cut core services? Many states have already done that, and cutting more services would only compound their troubles.
Devising tougher Medicaid and CHIP eligibility requirements? This, I believe, is not permissible under H.R. 3962, which prescribes a more standardized and less stringent eligibility requirements that the current Medicaid and CHIP regulations demand.
Opting out of the federally mandated Medicaid and CHIP Programs? Going down this road could lead to a constitutional crisis on the question of states’ rights versus the federal government.
Several notable Republicans have talked about invoking state sovereignty (the Tenth Amendment to the U.S. Constitution). Governor Tim Pawlenty (R-Minnesota), for instance, has suggested that Minnesota might cite this Amendment as a reason for not implementing portions of the (eventually) enacted federal health care program.
While Governor Pawlenty has been backtracking from this threat, there is a burgeoning state sovereignty (self-determination) movement in America. Nine states from conservative Georgia to liberal Washington have introduced bills or resolutions declaring self-determination under the Tenth Amendment. A dozen (mostly red) states have been contemplating similar legislation.
This recent self-determination movement has been most clearly manifested in health-related matters. As of July, 2009, 17 (mostly blue) states have either enacted and or have been moving towards comprehensive health care reform. The medical use of marijuana has become legal in 13 states.
An enactment of H.R. 3692 of S.1796, or a compromise measure will then most likely give a huge boost to the state-sovereignty movement.
I fear this development because Americans fought a bloody civil war to become the United States of America rather than these United States.
I believe that President Lincoln was right in waging that war—a house divided cannot stand.