Video - Four days after Gov. George Wallace, Terry Sanford offered a different vision for North Carolina.
WaPo | Republicans' consolidation of power in state capitols is likely to expand the number of states that employ a far more limited, free-market-oriented approach to implementing the nation's new health-care law than the robust regulatory model favored by its supporters.
Although the law is a federal statute, it leaves states to administer many of its most important provisions and grants them considerable leeway.
It is up to states to run markets, known as "exchanges," through which individuals and small businesses will be able to buy health insurance plans, often with federal subsidies, beginning in 2014. States will also oversee a mostly federally funded expansion of Medicaid to cover a far larger share of the poor.
Many incoming Republican governors made their antipathy to the law a plank of their campaigns. Tennessee Gov.-elect Bill Haslam denounced it as "an intolerable expansion of federal power." Wyoming Gov.-elect Matt Mead promised to join 21 states contesting its constitutionality in federal courts. And Maine, one of the first states to set up a task force to implement the law, will now be led by Paul LePage, a tea party favorite who vowed to work against the legislation and predicted that voters would soon see headlines about him telling President Obama to "go to hell."
Such state leaders cannot block implementation of the law: If they are unwilling or deemed unready to run an exchange by 2014, the legislation empowers the federal government to step in with its own version. But the law does grant states a fair amount of discretion.
The result, analysts say, is that two models are likely to appear: Democratic governors and legislatures will probably emphasize vigorous regulation and government oversight, while Republican state leaders will probably put greater stock in privatization and other free-market approaches.
"The character of what emerges in each state will in large measure be driven by the philosophy of its governor," said Michael Leavitt, a former governor of Utah who served as secretary of health and human services under President George W. Bush and whom many conservative state leaders are now consulting.
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