A states’-rights assault on healthcare reform

Just as healthcare consumers are beginning to see and like the benefits of the healthcare reform act, Republicans have launched yet another attack designed to disable the gains achieved by PPACA.  Earlier this week, US Senators Lindsay Graham [R-SC] and John Barasso [R-WY] introduced The State Health Care Choice act, which Slate describes as being…

written to allow states to opt out of the individual mandate, the employer mandate, expansion of Medicaid programs and “new federal requirements for regulating health insurance.”

Try this: Substitute “the Emancipation Proclamation,” “The Voting Rights Act of 1965,””the Interstate Highway System,” and “Social Security” for the last 18 words of that quote. How does that sound?

It seems clear that, knowing they don’t have the votes for a blanket repeal the Senate, and not being sure of how the courts will ultimately rule, Republicans are seeking a way to gut healthcare reform through the back door,  by asserting the age-old states’ rights ploy. Even casual students of US history know how well the states’-rights argument has worked for the American public: slavery, separate and unequal education, inequities in state-administered Medicaid programs, abortion rights. When states go their own ways, where a citizen lives becomes the determining factor in fairness, equality and access to services. And when states decide for themselves that they don’t have to comply with Federal law, what’s left?

The latest legislative move by Senators Graham and Barasso is a cynical way around a law [flawed as it may be] that, nevertheless, has many pluses for healthcare consumers. [See accompanying article on healthcare reform rules that took effect on Jan. 1, 2011.] Graham and Barasso call their bill another “dagger in the heart of Obama healthcare,” a fine example of toned-down political rhetoric, wouldn’t you say?

Graham and Barasso’s bill is clearly aimed at gutting healthcare reform before it has a chance to catch on among consumers. They’ve openly stated that they’re hoping half the states will opt out under the proposed law. That scale of non-participation would, of course, hollow out the core of healthcare reform, which is based on [nearly] universal participation via the individual and employer mandates.

In addition, the bill offers no replacement for the healthcare reform law, only the provision for states to opt out.  The result would be  a reversion to the un-reformed system in which healthcare insurers were free to trample on consumers at will. This new bill starkly contrasts with a state opt-out clause already included in the law signed by President Obama in March 2010. Under the 2010 healthcare reform law, states can, indeed, opt out–but to do so, they must get a waiver from the US Department of Health and Human Services [HHS]–and to get the waiver, they must submit a workable alternative plan for their state. That’s something that Vermont is already working on. The Vermont idea, with a proposed single-payer structure–is getting some positive publicity, and President Obama has said that he welcomes this kind of innovation in states.

Healthcare consumers and Congress watchers: stay vigilant.