After surviving near-death experiences on Capitol Hill, in the Supreme Court, and during the presidential election, the Affordable Care Act is now confronted with unanticipated sabotage in conservative state capitols. The passive aggression of many Republican governors and state legislatures, who are balking at implementing key elements of the law, threatens to create severe political blowback against health care reform upon its launch in a little over a year while undermining the effectiveness of the legislation. Policy analysts always recognized that relying heavily on states to administer the act posed major challenges, but the unexpected depth and breadth of state-level resistance has created the real possibility of a fiasco come 2014.
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