Health Reform: Federalism Rears its Head

A lead article in the New York Times today reminds us that the national health reform debate has taken place without sufficient consideration of the role of state legislatures and insurance regulators. Congress and the President have preferred to ignore the uncomfortable fact that the insurance practices they associate with insurance company abuses are in fact sanctioned by state officals with the legal authority to do so. A significant part of the opposition to national health reform is coming from state officials who view mandated Medicaid expansion, a mandated individual requirement to purchase insurance, and the superceding of state authority to regulate insurance practices as legal, if not constitutional, challenges. Another reason to slow this process down.