Paul Krugman: The Spite Club

House Republicans have voted 37 times to repeal ObamaRomneyCare — the Affordable Care Act,
which creates a national health insurance system similar to the one Massachusetts has had since
2006. Nonetheless, almost all of the act will go fully into effect at the beginning of next year.

There is, however, one form of obstruction still available to the G.O.P. Last year’s Supreme Court
decision upholding the law’s constitutionality also gave states the right to opt out of one piece of
the plan, a federally financed expansion of Medicaid. Sure enough, a number of Republicandominated
states seem set to reject Medicaid expansion, at least at first.