When former President Bill Clinton spoke at the Democratic National Convention, he argued that we must put aside ideologies to “get things done.’” The implementation of the Affordable Healthcare Act (ACA) is challenging Republican governors on exactly this point, and their responses are not uniform. Jan Brewer, governor of Arizona outspoken critic of President Obama and the ACA, has begun planning for, and implementing the healthcare exchanges that states must create under the rules of the legislation. States that fail to plan for exchanges will have exchanges created for them by the federal government. Six states with Republican governors have decided not to create exchanges, and may also not accept additional money from the federal government to expand Medicaid coverage along the lines set out by the ACA.
Is this just politics as usual, or is there an ethical dimension to this partisan debate? I would argue that to fight against Obamacare to the detriment of the health of a state’s citizens—the poorest of the states citizens—is a violation of a politician’s duty to beneficence. Uninsured patients suffer a preventable harm from the lack of access to healthcare, a harm that is now being remediated by the ACA, but only if only states will fully implement its policies.