There are a lot more Republican governors now. And they’re going to be very aggressive on the health care law, from trying to de-fund state participation in Medicaid to simply not building the state insurance exchanges that are central to the law. Many will also seek to join lawsuits arguing against the constitutionality of the individual mandate.
In addition, many state insurance commissioners are appointed, and new Governors may appoint regulators who do not see regulation as their primary responsibility.
But a big problem for supporters of the health care law, aside from the state meddling, is that the provisions they’ve implemented thus far just aren’t having the impact they expected.