Tim Pawlenty Sure Looks Like a Presidential Candidate

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Minnesota Gov. Tim Pawlenty hasn’t announced he’s running for president, but his recent actions regarding health care reform certainly seem to suggest he is.

Today, the governor signed an executive order prohibiting state offices from applying for voluntary federal grant programs created by the Affordable Care Act – unless they get permission from the governor’s office. One clause of the executive order says:

WHEREAS, consistent with this determination and in recognition of my obligations to protect Minnesota’s sovereign interests and those of its citizens, the boundary between state and federal government must be maintained to prevent an unwise and unsustainable federal takeover of health care in our State. (emphasis mine)

In essence, Pawlenty says he’s forgoing health reform grant funding to stop the federal government from trampling on states’ rights. This may be popular among health reform opponents and voters worried about government takeovers and intrusion.

But let’s have a look at what Pawlenty’s action might actually mean for Minnesotans. Broadly, it means that federal government could have more power over them than without the executive order. See, despite how vehemently health reform opponents insist the new law in unconstitutional and will be “defunded” if and when Republicans gain control of Congress, the law is the law. And pieces of the law that the states decide not to implement will still be implemented – just by the federal government.

For example, the Affordable Care Act directs states to set up health insurance exchanges. These are the web-accessible marketplaces where individuals and small groups will be able to compare plans, get subsidies – if they qualify – and purchase coverage. If a state doesn’t set up an exchange – like because its governor wants to take a largely symbolic stand against the Obama Administration – the federal government will do it. During the health reform debate, moderate Democrats in the Senate forced the final legislation to cede lots of power to the states that the more liberal House had wanted to give to the federal government. State-based exchanges, state-based health insurance cooperatives, state insurance regulation, etc. This state-centric approach is now providing a platform on which governors like Pawlenty are taking renewed stands against the law, and by proxy, Obama.

I might be a little less skeptical of Pawlenty’s motives if not for one glaring fact. He’s not running for re-election and will be out of office in January, meaning his successor could overturn this executive order with the stroke of a pen. The Democrat running to replace Pawlenty, Mark Dayton, has a nice lead over his Republican opponent, Tom Emmer, and Dayton’s platform includes support for single payer. It seems unlikely then that Dayton, if elected, will allow Pawlenty’s ban on federal health reform grants to stand. Meanwhile, deadlines for various federal grants are passing. Pawlenty already declined to apply for a grant to beef up the state’s insurance regulatory apparatus and today turned down a chance at $1 million grant to help start a Minnesota insurance exchange.

The big question looming for Minnesota, however, is what Pawlenty will do about Medicaid. The governor has already declined to take federal funding to expand the state’s Medicaid program ahead of the 2014 deadline called for under health reform, but he hasn’t yet said if he’ll apply for hundreds of millions in extra Medicaid funding available now as part of new legislation designed to help states get through the recession.

That’s the decision I’ll be watching to see how far Pawlenty will go to match action to rhetoric – and, in the process, avoid headlines like this.