Ever since the Patient Protection and Affordable Care Act was singed into law by President Barack Obama on March 23, 2010 it has remained a hot and polarized media topic as Republicans have tried many political avenues to repeal it. In popular shorthand, the policy has been termed “Obamacare” for it being the President’s signature legislation. Because the law involves a complicated interaction between state governments and the federal government, much of the writing on the topic has alluded to or centered on a discussion of federalism. Federalism is a political philosophy in which there is a central representing head of government which rules a body under authority given by a constitution and each individual ruled entity, or in the United States, each “state” retains it’s own author. What Obama has shown is just how it is difficult to enact large-scale political change when a large block of states opposes such legislation.
Federalism in the US is constitutionally backed by the tenth amendment which states that “The powers not delegated to the United States by the Constitution, nor prohibited it to the States, are reserved to the States respectively, or to the people” (United States Constitution, 1791).
Because many opposed the overhaul to the heal care system, the law was challenged before the supreme court of it’s mandating those who can buy health insurance who don’t paying a penalty. Peter Harkness wrote in Governing while the law was before the Supreme Court that if it was found legal that it could turn out to be “A case study for cooperative federalism.” He wrote “If the health reform law is upheld, the flexibility will give states on health insurance exchanges could be a model for healthy federal-state relations (Harkness, 2012, pg 1). Harkness’s tone is optimistic that should the law be upheld then it would lead to positive renewal of state-federal relations he thought had been slumping. Though the law was upheld, the optimism of state and Federal cooperation on the issue was more optimistic than Harkness predicted it would be. He wrote that the decision [would have] significant repercussions in the states” (Harkness, 2012, pg 2). He just misread what those repercussions would be. While the issue he was discussing, the mandate to buy health insurance with a penalty for those who can but don’t was upheld. “
The next month in the same publication Dylan Scott wrote that ‘For the first time, the U.S. Supreme Court declared an act of Congress to be unconstitutionally coercive toward states.” (Scott, 2012, pg 1). This was the other issue being brought towards the Supreme Court, as on whether or not the federal government could restrict existing Medicaid funding under the Affordable Care Act, should the states refuse additional funding of an expansion of Medicaid which would allow those at 133 percent of the federal poverty level to go on Medicaid. This would have led to an estimated 17 million people to the program beginning in 2014. The court’s rational was that this additional funding was not an expansion of the current program but a new program that could not be attached to the other.
As Dylan writes, this ruling had ramifications in many other areas of federal funding of state programs, most notably, education. More than half of the states, twenty six, argued that this was “unconstitutional coercion” since then if they refused the expansion, then voters in the states would be outraged that this action caused them to lose current benefits they were receiving through the program.
What Dylan predicted not only did not occur, but the exact opposite has happened with states against The Affordable Care Act actively undermining it. Jonathan Taplin wrote “The problems of the Affordable Care system point to the basic dichotomy inherent in a Federal system of governance.” (Taplin, 2013, pg 1). A centralized government is always less agile in being able to act and react than a more streamlined local government. Working to enact legislation that has wide reaching ramifications throughout the country require cooperation from states, and with many sate governors opposing The Affordable Care Act, such corporation is not only undermining this particular policy, but is putting into question the current condition of Federalism in the United States.
The Affordable Care Act is a policy originally drafted by Republicans. During the 2012 presidential elections, Obama frequently pointed to his opponent, Mitt Romney, who challenged this reform, that he had enacted a similar law in the state of Massachusetts while he was governor there. Taplin writes, “while a system of pure federalism might lead to less complexity as the states were left to devise their own solutions to education or healthcare, that is not the system we currently have.”
Had states on their own remedied some of the problems with the health care system, the Federal government would not have had to step in in an attempt to resolve the issue. Now, it is still up to political forecasters to see how this act will play out when some of its most important provision goes into effect in 2014. One thing that is certain is that this particular issue has raised the greater issue of the health of our current system of federalism.
References:
Taplin, J. TPMDayBreaker. (n.d.). Talking Points Memo. Retrieved December 8, 2013, from http://talkingpointsmemo.com/cafe/obamacare-kludgeocracy-and-new-federalism
U.S. Constitution. (n.d.). The United States Constitution. Retrieved December 5, 2013, from http://www.usconstitution.net/const.html
Harkness, P. (n.d.). The Affordable Care Act: A Case Study for Cooperative Federalism?.The Affordable Care Act: A Case Study for Cooperative Federalism?. Retrieved December 8, 2013, from http://www.governing.com/columns/potomac-chronicle/col-affordable-care-act-case-study-for-cooperative-federalism.html
Scott, D. (n.d.). Health Ruling Sets Up Potential Fallout for Federalism. Health Ruling Sets Up Potential Fallout for Federalism. Retrieved December 8, 2013, from http://www.governing.com/blogs/fedwatch/gov-supreme-court-ruling-potential-fallout-for-federalism.html
