Results Of State Legislatures, Ballot Initiatives Could Spark Conflict With Feds

Anthony Brino | Government Health IT | November 7, 2012

American voters considered 174 ballot measures in 38 states Tuesday and shifted the balance of power in several state capitals, in some places potentially setting up a battle between state and federal law.

With the loss of Democratic seats in Arkansas, legislative control in the South is now almost entirely Republican, for the first time since Reconstruction, according to Tim Story, a policy researcher and electoral historian at the National Conference on State Legislatures. Next year, 30 states will have Republican governors and 26 will be Republican controlled-legislatures and it's unclear, Story said, what this means for implementation the Affordable Care Act.

“My guess is it’s going to continue to be one of those things that they’re going to fight about," Story said. “That’s a time will tell question.” Many governors were waiting for the outcome of the election to decide whether or not to create state-based health insurance exchanges. More Republican governors may now be open to creating their own, when the other options — a federally-facilitated exchange and a jointly-run exchange — both include much more interaction with the federal government...