Republican victories in state elections across the country might be more likely to affect the implementation of the federal health reform law than the GOP takeover of the House of Representatives, the Los Angeles Times reports.

Although the GOP gained control of the House during last week's midterm elections, Democrats retained a majority in the Senate. In addition, President Obama is expected to veto any efforts to repeal the health reform law through federal legislation.

State-Level GOP Victories

During last week's election, Republican candidates gained at least 11 governor's offices, while losing three. The GOP also gained control of legislatures in at least 25 states. Prior to the elections, Republicans held control of 14 state legislatures, according to the Times (Levey/Japsen, Los Angeles Times, 11/7).

State Responsibilities Under Overhaul

State leaders are tasked with administering several key aspects of the health reform law, such as:

• Establishing and running health insurance exchanges;


• Overseeing an expansion of Medicaid;


• Setting standards for minimum benefits in health insurance exchanges; and


• Determining a process for reviewing health insurance premium increases.

Although state leaders lack the power to completely block the health reform law, they could exert considerable influence over the way the overhaul is implemented, the Washington Post reports.

According to analysts, Republican governors and legislators are more likely to emphasize privatization and other free-market approaches, while Democratic leaders might focus on government oversight and stricter regulation (Aizenman, Washington Post, 11/9).

Republican governors also could combat the health reform law by joining a multistate lawsuit challenging the constitutionality of the overhaul's requirement that all U.S. residents obtain health coverage by 2014.

In addition, GOP lawmakers might attempt to slow down the rollout of various reform law provisions through legislative processes.

Although California already has passed legislation establishing the California Health Benefit Exchange, no Republicans in the state Senate voted for the measures (Los Angeles Times, 11/7)

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