WASHINGTON — President Barack Obama's Patient Protection and Affordable Care Act celebrated its third birthday last weekend. This particular anniversary was a big deal, because it was often unclear whether the law would reach it. In the first place, it was imperiled by the Supreme Court; in the second, by the Republican Party's promise to kill it if Republicans won the White House in 2012. Over the past year, Obamacare survived both challenges, and next year it will begin its core mission of insuring tens of millions of Americans.
Republicans, however, haven't quite given up. Their slogan, "repeal and replace," has given way to "resist and annoy." Unable to get rid of Obamacare, many have settled on a strategy of making it function as poorly as possible. At the national level, House Republicans have refused to appropriate funds for implementation. At the state level, most Republican governors have refused to set up insurance exchanges, and many have refused to expand Medicaid.
The question, though, is whether governors who purposefully do a very bad job implementing Obamacare will hurt the law or just themselves and their states. Call it the California vs. Texas question.
In 2010, Gov. Arnold Schwarzenegger of California signed into law two bills to establish the online insurance marketplace — "exchanges" — that are at the center of Obama's health-care reform. In addition to being the first state to pass legislation implementing Obamacare, California promptly accepted the law's Medicaid expansion. By this time next year, when the expansion is fully underway, it's possible that the portion of the state's uninsured population will have declined from 20 percent to less than 5 percent.
In Texas, the situation is just the opposite. The Lone Star State isn't lifting a finger to create an exchange, instead leaving the work to the federal government. Texas is refusing Obamacare's Medicaid expansion, too. "The idea that we would expand and put more money and more people into a broken system is not unlike putting another 1,000 people on the Titanic," Republican Gov. Rick Perry told Forbes. "You know how this is going to turn out. And it's going to be a disaster."