Republicans Should Get Out of the Way of Obamacare

By Editorial Board, The Washington Post

03 September 13

FTER PRESSING for months, Michigan Gov. Rick Snyder (R) last week finally convinced his legislature to expand the state's Medicaid program as part of the national restructuring of the health-care system known as the Affordable Care Act (ACA). According to calculations from the Urban Institute, some 212,000 uninsured Michiganders now stand to obtain health-care coverage.

It's a sad fact that Mr. Snyder deserves congratulations for this accomplishment. You wouldn't think state leaders would need convincing to accept mountains of federal cash to help people with meager incomes obtain health insurance. But many Republican leaders and activists have waged a disruptive and harmful campaign to complicate, delay and undermine the ACA, which starts phasing in when state insurance markets begin enrolling customers in a month.

The most prominent efforts have been in Congress, where conservatives' latest move has been to insist on holding the government budget process hostage to obtain cuts in funds intended for ACA implementation. But the most disruptive activity has been at the state level. Twenty-one states have refused to expand their Medicaid programs, blowing a large hole in the ACA's coverage strategy. The Urban Institute estimates that 5 million people won't get coverage as a result.

As The Post's Sandhya Somashekhar reported last week, Republicans at the state level also have applied a variety of less visible measures to impede the law's implementation. Some won't enforce consumer protections, including a ban on insurance companies rejecting patients with pre-existing conditions. The result will be illegal discrimination. Another tactic has been restricting the work of federal "navigators," consumer assistants who help people understand their options and get coverage. The result will be more people without health insurance.

Though some analysts offer explanations for why state governments might make one or another of these decisions, states taking these steps are unwise at best. To the extent they represent a deliberate policy to derail the law, such steps are worse than misguided. Georgia's state government is doing "everything in our power to be an obstructionist," Ralph Hudgens, the state's insurance commissioner, boasted.

Congress enacted the Affordable Care Act. The Supreme Court found most of its provisions to be constitutional. Republicans, having opposed the bill and supported the legal challenge to it, are entitled to be unhappy about the outcome, though in our view they are wrong on the merits. They are not entitled to obstruct and flout the laws of the United States. On the contrary, they have an obligation to cooperate in good faith with wholly legitimate laws duly passed and reviewed by all three branches of government.