How Trump Killed the GOP’s Love of States’ Rights
From immigration to education to Medicaid, the new strategy is to impose a MAGA vision on America—whether or not states like it.
DONALD TRUMP SURE DOES love to hate California.
Since taking office, he has blocked the state’s tight vehicle emission standards from taking effect, attacked its public schools over trans athletes and “DEI” issues, repeatedly threatened to withhold disaster relief after the devastating forest fires, and tried to yank federal financing from if California doesn’t do more to enforce his immigration agenda.1
All of that is on top of commandeering the state’s National Guard—and calling in the Marines—to quell protests against the immigration crackdown.
Of course, beating up on California is nothing new for Trump, or for his allies. The state has been a conservative bête noire for decades, thanks to its leading role in causes like same-sex marriage and environmental protection. Today its embrace of immigrants and ties to Hollywood liberalism make it a symbol for everything the MAGA movement believes is wrong with America—a place to be denigrated and punished with rhetoric and, increasingly, with policy.
But the attacks on California have become so familiar it’s easy to miss that they are a sign of a broader shift away from what has been a bedrock GOP principle: states’ rights.
This is no small thing. The danger of federal overreach has been a staple of Republican rhetoric for most of the modern political era, deployed in order to block everything from the landmark civil rights efforts of the 1950s and ’60s to the environmental and consumer-protection laws of the ’70s and ’80s. More recently, warnings about too much federal power figured prominently in arguments Republicans made against the Affordable Care Act, or Obamacare, which they said imposed a national solution for health care on states that didn’t want it.2
You can still hear versions of those arguments, especially in courtrooms when red states challenge older federal regulations put in place by Democratic administrations. But these days you’re more likely to find Trump and MAGA Republicans on the other side of the federalism divide.
Instead of trying to curb the power of Washington, they’re deploying it so they can impose their governing vision on recalcitrant states—through the kind of actions Trump has been taking against California and, they hope, through the legislation they are now trying to get through Congress.
THAT LEGISLATION IS THE One Big Beautiful Bill Act, which the House passed in May and the Senate is debating.
The biggest spending cuts in the bill are to Medicaid. And the biggest chunk of the Medicaid cuts are from new “work requirements” under which enrollees could not qualify for the program unless they demonstrated that they have a job, are engaged in another qualifying activity (like community service) or have a valid reason for not seeking work (like caregiving responsibility for a young child).
Medicaid is a joint federal-state program: Washington provides the majority of funding and sets parameters for how it should work, then leaves administration to the states, which have to kick in the rest of the funds. The arrangement has always given states some flexibility, including through waivers from the Department of Health and Human Services that states can seek if they can demonstrate what they want to do with Medicaid is consistent with the program’s overall goals.
Republican state officials from more conservative parts of the country have for years sought to introduce work requirements, only to be stymied by HHS officials or federal judges who said conditioning Medicaid on work was not in keeping with the program’s goals of expanding access to health care. The legislation Trump and congressional Republicans want to pass would effectively remove that obstacle.
But the new legislation wouldn’t simply allow states to impose work requirements. It would require them to do so. And it wouldn’t leave states much discretion over how to do it. The legislation stipulates that states must take into account work status for at least the previous month, and verify eligibility at least every six months.
The only real leeway states have would be if they chose to limit enrollment even more aggressively by taking into account work history for longer than a month.
Throw in some other new rules the legislation would force on states—like prohibiting them from paying for gender-affirming care, or using their own money to cover undocumented immigrants—and the pattern is clear.
“Conservatives have long espoused states’ rights, but with Medicaid, Republicans are now seeking to impose a more limited version of health coverage on states,” Larry Levitt, KFF executive vice president, told me over email this week.
Implementing all of this would be difficult. Among other things, states would need to create new data systems and hire new people to manage the verification process. That’s going to cost a lot more than the $100 million the legislation would award states to help defray the expense.
Georgia alone spent $50 million to implement its work requirement, as a recent article in Governing magazine pointed out. And enrollment in Georgia’s system has come in far below expectations, in part because there don’t seem to be enough staff to help beneficiaries deal with the new paperwork requirements.
Not so long ago, congressional Republicans would decry this sort of command as an “unfunded mandate”—a wild abuse of power by Washington over the will of the states.
But that was then. Now, Trump’s in charge.
THE BIG BEAUTIFUL BILL’S cuts to the Affordable Care Act also flip the script on states’ rights.
Even though Obamacare put in place some big, transformative changes, like prohibiting insurers from denying coverage to people with pre-existing conditions, the law left states with lots of discretion over how to manage insurance within their jurisdictions.
Among other things, the Affordable Care Act allows states to operate their own online marketplaces, which is why Marylanders buy plans through the Maryland Health Connection and Idahoans go to Your Health Idaho instead of using HealthCare.gov.
This deference to states was no accident. Democratic leaders putting together the Affordable Care Act in 2009 and 2010 had to appease more conservative lawmakers within their caucus who—like their GOP counterparts—were wary of federal dictums and power. The decision also had a powerful practical rationale: State insurance regulators have lots of experience, and more specialized knowledge of their local market idiosyncrasies.
Among the states to use that discretion more aggressively has been California,3 whose marketplace, Covered California, has long been regarded as among the most successful in the country.
One example of how Covered California has innovated is by giving open enrollment more time than HeatlhCare.gov does—which, this year, meant allowing enrollment up through January 31, 2025 rather than January 15. Officials in California believe the extra time brings in more people, especially more marginal customers who otherwise might not get around to it. Those people tend to help insurance risk pools, thus holding down premiums, because they are often in better relative health.
The state can do this, Covered California director Jessica Altman told me in a phone interview, because California has developed systems and technology to process applications quickly so that even people applying at the end of month can have coverage that starts on the first day of the next one. But if Trump and his allies get their way, it won’t matter: The Republican bill would limit open enrollment to just seven weeks, running from November 1 to December 15, even for states like California that would prefer to allow more time.
And that’s just one of the ways Trump and the Republicans would restrict state officials administering the Affordable Care Act. Through legislation and regulation, Trump and Republicans have proposed requiring new, onerous processes for people who get insurance—including a prohibition on automatic re-enrollment in many circumstances, even though that is how employer coverage and other forms of private insurance typically work.
The cumulative effect of these changes will be to depress enrollment. That appears to be more than fine with Trump and the Republicans. But it’s not what California’s leaders think their state wants—or needs.
“When we don’t have those flexibilities anymore,” Altman said, “we can’t meet the moment for consumers in the way that we have in the past—and the way that we absolutely want to in the future—and that’s really the problem of the one size fits all approach that that we’re now seeing.”
AS TRUMP AND HIS ALLIES in Washington have claimed more state power for themselves, Democrats have pushed back, whether it’s championing the rights of local or state authorities to defy federal immigration dictates or defending California’s rights to set emission rules as it pleases.
It’s a reminder that, for Democrats as well as Republicans, the fight over federalism may have less to do with principle about which level of government best serves the public and more to do with the balance of power between the two parties.
Today, Republicans control the White House and Congress. More federal power means more opportunities for them to impose MAGA’s will on the rest of America, and so of course they’ve learned to live with—and even prefer—centralizing authority in the buildings that line and surround Pennsylvania Avenue.
Republicans control much of the judiciary too, through judges they’ve put on the federal bench, including the Supreme Court. And while these judges still land on the side of state authority regularly—as they did when the high Court’s justices allowed state abortion prohibitions in Dobbs—they are not afraid to override state power, as they did when they invalidated New York’s concealed carry law.
As University of Michigan Professor Nicholas Bagley put it to me this week, “Federalism is invoked opportunistically by whichever party is out of power.”
Still, if both parties can rationalize using federal power when they have it, there are some very clear differences in the ways they do it. Democrats look to set minimum standards for things like economic security, environmental regulation, and the protection of marginalized groups, with room for states to go above and beyond those standards. Republicans look to set limits that states cannot exceed, while allowing them discretion to do less.
In that sense, the fight over federalism actually is the same fight the two parties have been having for generations: Not so much over who directs the change in America, but what that direction that change takes.
Though a judge this past week rebuked them on that.
Arguments about alleged federal overreach eventually prevailed in the landmark 2012 Supreme Court ruling on Obamacare, which mostly allowed the law to go forward but struck down a requirement that states expand Medicaid, citing conservative arguments that such a requirement was “coercive.”
California has always been a leader in efforts to expand health care access, going all the way back to the Progressive Era when it was one of two states—New York being the other—where an early version of universal health care got serious consideration from officials. After the ACA became law, California was the first state to pass legislation bringing its laws into line with the new federal guidelines. That’s also when it created and funded what became Covered California.
Jonathan, The Bulwark really scored when they hired you! This is tremendously depressing, but fantastic reporting.
Perhaps MAGA and the Idiot-In-Chief have no core principles whatsoever. Just idiocy to harm others.