If and when President Barack Obama affixes his signature to the health care reform bill currently percolating in Congress, don’t expect it to be the last word. In fact, this exceedingly long chapter in our nation’s history looks like it might turn out to be simply a prelude to a war that will be fought on the state level for years to come.
If we are to believe today’s version of the venerable New York Times, and we have no reason to think they are fibbing to us, Pennsylvanians are about to see a swarm of health care industry, labor, insurance industry and consumer advocacy groups descend on our state capitol like locusts. They will clog your airways, Inboxes and mailboxes like cholesterol. And they know where you live.
Some conservative groups are already advocating changes to state constitutions that would prohibit the feds from forcing health care policy decisions on the states. On the scale of one to loony, this falls squarely on the loony side, considering anything the feds pass will supersede state constitutional amendments. Oh, and it might be a bit awkward for states to tell the federal government to get out of their health care kitchens while at the same time asking for Medicaid funding increases. “Leave me alone, but give me more money!” is rarely a good strategy. But hey, details…
On the slightly less loony side will be the real battles, which will be fought over the implementation of specific sections of the federal law at the state level. This is where we can expect the real nastiness to ensue, as we have already seen. Anyone remember the point where Congress was considering the state “opt-out” provision for a public option? It took about 8 seconds for some governors to leap out of their seats and yell “Not on my watch!” Expect similar skirmishes to develop.
Finally, let’s not forget that we are, in fact, in Pennsylvania, where politics is a blood sport. Does anyone think that the implementation of health care reform won’t be the marquis issue for House Democrats, who cling to a 104-99 majority? How about for the House GOP, many of whom are convinced that Obama’s health care reform will be the albatross that sinks the Dems? And how about every one of the gubernatorial candidates?
Progressives in Pennsylvania are salivating for this fight, as are their conservative counterparts. Both sides think this issue is a dead, solid winner for their electoral base. And that may very well be the case, but it isn’t gonna be the base of either party that elects the next governor, or determines control of the state House.
The health care battle is coming to a theater near you. And it will be an extended engagement.
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