A reasonably balanced piece in the New York Times today explains why, despite the drama of the shutdown, the most serious Obamacare battleground may be the states.
As many of you know, a chunk of the Obamacare law is little more than a raw expansion of existing welfare programs – that is, dropping millions of people into Medicaid. And for proponents of the law, that could be a problem, because Medicaid is run by the states. And Republicans run some of those places.
The Supreme Court ruling that allowed Obamacare to stand, as the New York Times makes clear, also provided it with an Achilles Heel:
But in June 2012, the Supreme Court ruled that states could opt out of Medicaid expansion. The ruling opened the door for conservative opponents of the law. Americans for Prosperity, with paid staff members in 34 states, walked through it. So did another group, Tea Party Patriots, which recently gave $20,000 to organizers of a referendum drive to put the question of Medicaid expansion on the Arizona ballot.
This is trench warfare. But Obamacare opponents don’t have to take every trench to win, because remember, health care providers need bodies to treat in order to earn enough to make the system work:
Expanding Medicaid, a joint federal-state program for the poor, is critical to the law’s goal of covering the nation’s 48 million uninsured. Hospitals and insurers were also counting on more Medicaid patients to make the economics of the law work.
This work is not as glamorous as a 21-hour filibuster. But, unless Republicans soon gain control over all three branches of government, it may be more relevant to the question of whether Obamacare will survive.