The Health-Care-Reform Trickle-Down: What It Means When States Take Things Into Their Own Hands

Health-care reform may be a ways off from becoming law, but at least a few of its provisions and debates that it started have already trickled down to the states—and not in a way that Democrats would want.

RH Reality Check, a pro-choice reproductive-health blog, points out two places where you now see legislative fallout from Congress's heated abortion debate. The Kansas legislature is now considering a bill that would require all abortion coverage to be purchased as a rider, similar to what would have been required under the House bill’s Stupak Amendment (or, depending on how you read it, probably under the Senate language, too).  Meanwhile, in North Carolina, Wake County has dropped its coverage of elective abortions, in a move that looks like it might be taking a page from the Republican National Committee’s reactive ditching of their abortion coverage. Taken together, the two moves to limit abortion coverage can suggest that a national, highly publicized debate over abortion and insurance coverage may not play out in the pro-choice movement's favor. More from RH Reality Check:

The biggest fear that reproductive rights advocates had when the Stupak-Pitts amendment was introduced into the health care debate was that that women would lose existing insurance coverage for abortion care, now held by 87 percent of women with private insurance plans …These moves in North Carolina and Kansas show that governments are already taking it upon themselves to pre-emptively eliminate coverage before health care even passes.

Imagine the irony if health care reform itself fails to pass, and the only lasting legacy from the endeavor is the growing removal of reproductive health care from insurance plans in both the public and private sector.  

Combine this with the Health Freedom Acts that have shown up in Virginia, Florida, Idaho─bills that make a pre-emptive attempt to declare state-mandated insurance unconstitutional, you get the sense that the state-level change the health-care-reform debate has inspired isn’t exactly what Obama and other Democrats had in mind as the change we need.

What’s most important about these legislative efforts, I think, is they highlight what’s at stake for Democrats if they cannot pass health-care legislation. We’re not necessarily talking about moving back to the 2009 status quo, where Democrats did not gain anything, but did not lose anything either. Instead, if states like Kansas and North Carolina get there way—and others, fed up with Washington gridlock, become emboldened by their success—we’re looking at a potential health-care landscape that’s less favorable to their voters. And if Democrats really want to frustrate their constituents, making things worse than when they started this whole health-care effort seems like a pretty good way to do so. Which, yet again, convinces me that Democrats are best served, both politically and polic-wise by getting their act together and getting health-care reform out the door.