On the eve of the possible passage of a health care bill, Arizona has provided a glimpse of our possible future by shutting down its SCHIP program and booting a bunch of people out of Medicaid:A couple weeks ago, I wrote on the collapsing legitimacy of the government:The Arizona budget is a vivid reflection of how the fiscal crisis afflicting state governments is cutting deeply into health care. The state also will roll back Medicaid coverage for childless adults in a move that is expected to eventually drop 310,000 people from the rolls.The reason this is so troubling, of course, is that the new proposed health care plan gets about half of its coverage expansion through adding people to Medicaid. The state side of this expense doesn't show up on the books as a government expenditure (neatly enabling the bill to get a lower CBO score), but someone in America has to be taxed to pay for it, and there is a big problem when tax revenues fall short of the required expenditure.
Now think about the entitlements in general, and the health care bill in particular; "unfunded mandate" is the key term here. The states are having enough budget problems without taking on more. The Commerce Clause is an awfully weak pole to hold up this tent. All it will take is a couple of Governors telling the Fed.Gov to stick it where the sun don't shine.I have to say that I didn't expect to see things accelerate this fast - that's certainly not a good sign for the Democrats. We can (ahem) deem their day to be passing ...
And here's the beauty of it all: the people won't have to contest the bill with powder and lead, all they'll have to do is support their Governor's passive resistance to the bill. This is very likely to be wildly popular in lots of places, and might very well snowball to a majority of the states. The actual Constitutional Crisis will be when the Fed.Gov tries to use the courts to enforce this, via the Commerce Clause.
I think that this is how it will play out, with the governors of Texas, Utah, and Montana playing the role of Andrew Jackson. The Supreme Court has has made its decision; now let it enforce it.