A quick check of the timeline shows that health care reform was signed into law in March 2010, its "individual mandate" portion that requires Americans to obtain health insurance was upheld by the U.S. Supreme Court last June, and the Republican presidential challenger who vowed to repeal and replace the law was defeated earlier this month.
Whether you love or loathe health care reform, the clock has run out on eleventh-hour challenges and Hail Mary plays. The game is over. The Affordable Care Act, most of it anyway, is here to stay, nearly three years after Congress passed it and President Barack Obama signed it.
Even here in my home state of Florida, which led the 26-state uprising against the law and whose governor turned down millions in federal funding for a state health insurance exchange, suddenly most of the foot-dragging has ceased.
Florida's state lawmakers sent a letter of rapprochement last week to Health and Human Services Secretary Kathleen Sebelius, noting that they'd heard something about these state exchanges and are kinda curious how they'll work. Gov. Rick Scott went a step further and asked Sebelius for a sit-down to brainstorm how to cut health care costs.
That's huge. Really. As polarized as this country has been over health care reform from day one, the shift from "Hell no" to "Hell maybe" is enormous. Sebelius even tipped her hat to such baby steps last week when she agreed to give the holdout states more time to ponder their approach to exchanges, which the feds will run in states that ultimately decide to pass.
What's bringing about this sudden softening? Well, at the risk of summoning ghosts of the recent presidential campaign, I'll nominate the F word: facts. What's happening in recalcitrant states such as Florida is that the suddenly refocused number-crunchers are doing the math and figuring out that -- wait for it -- health care reform can save them money!
A report published last week by the Health Policy Institute at Georgetown University shows Florida can save up to $100 million per year by expanding Medicaid to include up to 1.3 million uninsured Floridians. The feds have offered to pay 100 percent of the Medicaid expansion through 2016, then phasing down to 90 percent from 2020 on. Ironically, it was a mandatory version of that very expansion that Florida and other states fought and ultimately convinced the Supreme Court to block last summer.
This health care detente is not likely to go smoothly. While even the most entrenched state leaders must make a nod to inconvenient facts, there remains widespread suspicion of the federal offer to fully fund Medicaid expansion in the initial years. What's more, fewer than half the states will be ready to open their own individual and small-business insurance exchanges in January 2014 without federal assistance.
The good news is, the clock has finally stopped working against health care reform and instead started ticking on laggard states to get on board or be left behind.
Follow me on Twitter: @omnisuarus.
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