Now that the Supreme Court has ruled Obamacare constitutional, a growing chorus of Republicans, including Louisiana Gov. Bobby Jindal and Wisconsin Gov. Scott Walker, are urging states to simply refuse to implement the law. Do they actually have that chance?
On Fox News on Thursday night Jindal declared, "Absolutely, we're not implementing the exchanges. We're not implementing ObamaCare" following the Supreme Court's ruling that Obamacare is constitutional. Wisconsin Gov. Scott Walker's reaction to the ruling was essentially the same thing: "Wisconsin will not take any action to implement ObamaCare." And Sen. Jim DeMint of South Carolina has called on "every governor to stop implementing the health care exchanges." Some said the pledges hint of the "nullification crisis" when South Carolina defied President Andrew Jackson and a federal tariff. But, despite the Supreme Court's ruling that states can opt out of a Medicaid expansion, there's not much that Jindal and Walker can do to prevent health insurance exchanges from being set up in their states.
In Jindal's case in particular, while his defiant quotes might please conservative fans, his statement changes nothing in Louisiana. If the states won't set up their own exchanges, the federal government will run the exchanges for them. Louisiana has joined not-so-red-states Maine and New Hampshire in letting the federal government set up its exchange. "There hasn’t been one state that has a finalized exchange yet," the Heritage Foundation's Nina Owcharenko told Talking Points Memo in response to DeMint's call for inaction. "Even states that are anxious to get an exchange up and running, it’s taking a lot longer than they expected. And a lot of governors have said they don’t plan on setting up an exchange, and just plan on having the federal government being the default."
As the Associated Press' run-down of each state's progress toward implementing the law shows, most states haven't gotten very far. In fact, in Louisiana, the state had already decided to let federal government take over before Jindal faux-declared war on Obamacare on Fox. Wisconsin had made some progress on setting up the exchanges, but Walker put a hold on the process in January, saying he wanted to see what the Supreme Court decided and would not do anything until after the November election.
What about the other part of the Court's ruling, that the federal government couldn't coerce states into expanding Medicaid coverage by threatening to cut off all Medicaid funding if they didn't comply? That's less clear. Indiana Gov. Mitch Daniels -- who, unlike Jindal, is not considered a potential running mate for Romney -- said he was taking time to absorb the Obamacare ruling. The state legislature will decide whether to expand Medicaid, Indiana News Center reports. Ohio Gov. John Kasich released a statement saying, "We are very concerned that a sudden, dramatic increase in Medicaid spending could threaten Ohio’s ability to pursue needed reforms in other areas, such as education." While the federal government would pay at least 90 percent of the cost of expansion, some states say the remainder is still too much. As Margot Sanger-Katz writes in National Journal, if states refuse to expand Medicaid, there's no other provision in the Affordable Care Act to cover the very poor. "The decision puts these poorest residents in a difficult position. They’ll be required to buy insurance but ineligible for Medicaid," she writes. Daniel Hawkins at the National Association of Community Health Centers tells her, "you are effectively consigning them to health insurance hell.”