States may have more say in health law

Pennsylvania’s next governor, Tom Corbett, is one of many Attorneys General challenging the federal health overhaul in court. WHYY asked experts what’s ahead as Corbett and a Republican House majority take their places in Harrisburg.

Pennsylvania’s next governor, Tom Corbett, is one of many Attorneys General challenging the federal health overhaul in court. WHYY asked experts what’s ahead as Corbett and a Republican House majority take their places in Harrisburg.

Many Republicans campaigned on a pledge to “repeal and replace” the health law, but experts say that’s unlikely.

Republicans don’t quite have the numbers to override a presidential veto. Still, President Obama’s health secretary may have lots of explaining to do.

Mary Agnes Carey is with Kaiser Health News.

Carey: Fred Upton, who’s a Republican congressman from Michigan, has joked that Kathleen Sebelius will have to get her own parking space at the Capitol, that she’ll be called up there quite a bit.

Carey says Republicans do have the power to throw up roadblocks or perhaps underfund important initiatives. She says state-level Republicans may coordinate their efforts with federal lawmakers to oppose key parts of the law.

Carey: If a governor and a legislature at the state level chose not to do some of these things, the federal government would do it for them, and some governors — no matter what they say in their elections might be loathe to let the federal government come in their state and run an exchange or they might say: ‘It’s OK, go ahead do it.’ So I think that’s one area that we’ll be watching closely.

Each state is supposed to set up a marketplace — a one-stop shop — where individuals and small businesses can buy insurance.

Carey says states have a lot of responsibility in the health law implementation. She says Corbett and others may slow the roll out by seeking waivers or arguing that certain provisions are too expensive.

Mark Pauly is a professor of health care management at The Wharton School at the University of Pennsylvania.

He says much of the health law roll out is not written into law but a matter of politics and discretion.

Pauly: My guess is that there will be more flexibility there, in terms of how quickly they have to move and may be even how much of it they have to bear the cost of. I think the compromise ought to rule the day here and allow states to have a lot more choices as to how they will do these things and at what pace.

Pauly says many state-level Republicans are wary about the the federal government’s promise to help fund the expansion of the Medicaid public health plan. Pauly hears compromising tones on implementing the Medicaid expansion but says he expects many Democrats to hold the line when it comes to new rules for health insurance companies.