Due to the passage of the Patient Protection and Affordable Care Act (PPACA), the nation’s health care system is on its way to undergoing a tremendous overhaul. The impact of the implementation process will be felt by all, but state and local governments will play a significant role.

As former Heritage senior fellow Dennis Smith writes in a recent paper, “While the White House would like to give the impression that the debate on health care is over, the truth is that it has just begun. Like welfare reform legislation in the past, there are really three phases to reform. An act of Congress is just the first; now reform passes to the state level and eventually to the local level, and it is at the state and local levels that the real impact on the country’s citizens will become apparent.”

According to Smith, the states stand to lose substantially due to the enactment of Obamacare. First of all, the new law will make a severe dent in the federalist system upon which the nation was founded, overriding states’ authority. Second, Obamacare marks an enormous expansion of federal bureaucracy. Writes Smith, “If HHS chooses to micromanage each particle of the exchanges, failure is all but guaranteed simply because the regulatory and procurement process will force states to miss deadlines.” Finally, Obamacare will create a financial drain on the states, as certain provisions related to the expansion of Medicaid will expire after only a few years, leaving states to fill the hole.

So what can states do? Smith outlines the four following suggestions:

  1. Hold Washington Accountable. “Federal officials obviously control the regulatory process, but states should demand, individually and collectively, that the federal government respond to their priorities.”
  2. Insist of Rule-Making for Medicaid. “States should insist that, instead of issuing a single, mammoth Medicaid rule, HHS should issue separate rules so that all issues will receive proper attention.”
  3. Protect State Interests Using the Courts. “States should challenge HHS whenever it undermines state authority.”
  4. Keep Citizens Engaged Throughout. “State officials have an obligation to fully explain the impact of this new law on their citizens and create the public forum for holding federal officials accountable.”

The PPACA thwarts the independent efforts of the states to enact and implement their own version of health care reform, but states should not go down without a fight. By continuing to actively engage the federal government as Obamacare is put into practice, states, along with their citizens, can continue to fight the battle against a Washington-run health care system.