In 2009, when Congress passed the health care bill, only one Republican voted in favor. In 2010, using opposition to the new health care law as their rallying cry, Republicans gained 63 seats and control of the U.S. House of Representatives. They also won control of both the legislative and executive branches in 11 additional states, bringing their total to 25.
Last week, on Oct. 1 — the first day of the new federal fiscal year and the launch of the new health care exchanges — the victors of 2009 collided with the victors of 2010. The entire nation felt the impact.
Even when it ends, the government shutdown will have demonstrated the willingness of Republicans to try everything to stop the health care law. Already, well-funded state campaigns are trying to persuade healthy young people not to buy health insurance through the exchanges. If successful, these campaigns will hike premium rates for those who do sign up, spawning dissatisfaction with the new law.
The health care law finances "navigators" to help people sign up, similar to what Medicare has. But red states are hamstringing navigators, often requiring them to pass licensing exams, obtain insurance bonds and pay heavy fees. The more problems people have with the exchanges, the greater their dissatisfaction will be with the new law.
Given this level of intransigence, what is to be done? I believe the country, and the Democratic Party, would be better served if Republican-controlled states were allowed to opt out of the Affordable Care Act, but only if they agreed to three conditions:
• First, opting out requires opting out of all provisions of the law. No individual mandate. No health exchanges. No requirement that insurance companies spend 80 percent of the premium dollar on health care and cover people with preexisting conditions.
• Second, those states that are implementing the health care law will be given great latitude in designing their new health systems. Several states, for example, want to create a single-payer insurance system similar to what Canadian provinces have had for almost 50 years. The existing law allows them to do so only in 2017. They should be allowed to do so in 2014.
• Third, the people of withdrawing states must clearly support the opt out. The legislature must pass a bill. The governor must sign it. And a ballot referendum must be passed.