10 Untold Truths About Health Care Law State Officials Hope You Miss

Updated May 2012: To clarify it’s overall message: State officials hope you miss the truths listed here simply because most of them and their predecessors in office have painted themselves into a corner.

Please share this with anyone you know who does not want the health care law implemented. While this article has been written from a Nebraska perspective, the basic facts and information are applicable everywhere.

Few Americans are aware that the health care law was written to be implemented step by step by the States.

An Associated Press story, published in many newspapers Saturday and Sunday, January 22 and 23, including in the Lincoln Journal Star¹For some reason, the online article has disappeared from the Journal Star site., was the most straightforward article on the subject to be widely distributed to date.

The headline:

"Health Care overhaul debate now shifts to the states"

The opening lines from the story really say it all, so it's important to read them carefully:

"True or false: States suing to overturn core requirements of President Barack Obama's health care overhaul are refusing to carry out the law. If you said "true," you'd be wrong.

Republican state legislators and governors are working on how to deliver coverage to more than 30 million people now uninsured, as the law calls for, even as GOP attorneys general lead the legal battle to overturn the law's mandate that most Americans have health insurance."

While the rest of the AP story requires a number of clarifications and even a few corrections, those opening paragraphs are indeed accurate. If the American people do not become aware of some basic facts, particularly regarding their State's role in implementing the law, it will be implemented. State officials are  silently hoping people don't figure out the details. While most Americans are looking the other way, state legislators, bureaucrats, and governors have already taken steps to implement the law.

I believe it's a relevant question to ask: Does the status of the health care law as described in the AP article sound like it fits the narrative told by national media or crafted by elected officials and the Republican Party in your state?

I know it does not fit the one that has been woven here in Nebraska over the past year. Had I not been researching and monitoring developments, I would have believed the following mythology:

Health care is national issue, it is being imposed upon the States by the Federal government, and, therefore, implemented by the Federal government. The story has been told as follows...We are just sitting ducks and our State officials can’t do anything to stop it. Blocking the Federal government’s imposition requires Federal level solutions which are limited to the Federal court system ruling on the multi-state Attorneys General lawsuit challenging the individual mandate, but, particularly, the final answer lies in a repeal by Congress.

Implementation of the health care law in Nebraska means the difference between being able to fund education or bankrupting our state’s Medicaid program. Because of this choice, our Governor committed to do everything he could to fight implementation of the law. Late this summer, Nebraska’s Governor Heineman held a press conference to explain a study he’d commissioned, documenting exploding costs that will be incurred by the State’s Medicaid program under the health reform law.  He then called upon Nebraska’s teachers to disavow the reform, and urged the State Board of Education to pass a resolution condemning the health care law. For a couple of weeks, there was a flurry of media appearances and stories. Sparring occurred between the Governor and Senator Ben Nelson, the Governor and the teacher’s unions, and local news cameras even followed Board of Education member Robert Evnen into a meeting to watch the drama unfold.

The Republican Party of Nebraska made clear to county and state convention delegates and later, to voters, that voting Republican would mean the health care law would be stopped. What was made very clear was that stopping the health care law’s implementation particularly required the re-election of the state’s three incumbent Congressmen; Jeff Fortenberry, Lee Terry, and Adrian Smith, who would vote for repeal. Further, re-electing the State Attorney General, Jon Bruning, was critical so he could continue working on the multi-state lawsuit, which he had "led".

These myths can be debunked, one at a time, with basic facts:

• Fact #1: Participation by the States in the Federal health care reform plan is OPTIONAL / VOLUNTARY. There are actually two opt-outs available.

• Fact #2: The health care law is not a purely Federal program; because it is an optional program, States may participate in it or not.  BUT States are responsible for the overall implementation.

• Fact #3: Absent some extremely rare exception being granted by the U.S. Supreme Court, the multi-state lawsuits challenging the constitutionality of the health care law will take  two to four years to work their way through the court system.

• Fact #4: Congressional repeal is not a realistic possibility until at least 2013.

• Fact #5: The health care law’s implementation actually began before the health care law was even passed, due to little known provisions in the February 2009 Stimulus bill. Implementation and preparedness has been underway since the health reform bill passed, particularly since this past summer, and will continue in stages until the final "brick" falls into place in 2014.

• Fact #6: Because implementation is already underway, the Attorneys General lawsuit, even if successful, and a 2013 Congressional repeal will come too late to unravel the many fundamental changes to our health care system that will have already have taken place.

• Fact #7: Legislation introduced by State Senators (or Representatives in all other states) that either purports to nullify the law or tackle single issues or elements within it WILL NOT STOP THE LAW’S IMPLEMENTATION.

• Fact #8: Health care’s opt-out clauses provide an opportunity to truly reform health care within the States, the right way.

• Fact #9: In order to prevent the health care law from being implemented, a truly significant number of citizens who grasp all of the problems would have to be willing to work hard over a sustained period of time.

• Fact #10: Stopping the health care law’s implementation requires a focus on State governments and, therefore, a shift away from focusing on Washington, D.C.