President Obama announced support for a plan that would allow states to opt out of certain key requirements of the Affordable Care Act (ACA) in 2014 instead waiting until 2017. States could be granted a waiver from provisions such as the requirement that most Americans purchase insurance or that employers offer their workers coverage.
The ACA already stipulates that waivers could be granted in 2017. If a state knows it wants to implement its own plan in 2017, it makes sense that they shouldn’t have to go through the expense of ramping up for one set of requirements in 2014 (when the ACA goes into effect), only to go through the additional expense of changing its plan in 2017.
On the PBS NewsHour last night, Judy Woodruff interviewed first Kathleen Sibelius and then Orrin Hatch on the issue (Sibelius being the Secretary of Health And Human Services (HHS) and Hatch the conservative Republican senator from Utah). Woodruff repeatedly tried to confront Hatch’s opposition to the proposal. She would cite a state governor who wanted the flexibility of the 2014 waiver option — for example, someone who thought his state could do better than the federal plan if it offered a single-payer system – only to have Hatch repeat, over and over, that the states can’t afford to implement health care reform, so there’s no point in talking about it. It’s all “bull corn.”
Normally I have a hard time sitting through interviews that are devoid of content and ramp up emotions with words like “socialism” (“If President Obama is reelected … [we’ll have] socialized medicine”). Or listening to sentiments like “[P]eople got health care before. They had to go to emergency rooms, but they got it.” But I was exercising, so I stuck with it.
Single-payer may yet prevail
The idea of advancing the date when states can receive a waiver is ensconced in a bill put forward by Senators Ron Wyden (D-Ore.), Scott Brown (R-Mass.), and Mary Landrieu (D-La.). It’s called the Wyden-Brown Bill.
In an article in The New England Journal of Medicine, a conservative thinker from the conservative think tank Heritage Foundation enumerated his objections to the bill. They’re not unreasonable. One concerns the inability to combine all health programs administered by the states – including Medicare, Medicaid, SCHIP, Taft-Harley – into one single-payer system.
The other complaint is more directly political.
[S]ince ultimate waiver authority rests with the HHS secretary, the waivers granted would probably reflect the administration’s preferences. Senator Wyden claims that his legislation would allow conservative states to opt out of much of the ACA and implement consumer-driven coverage. But he admits that the secretary, not the state, has the final word over what is permitted. That was also true of the SCHIP legislation enacted in 1996: it permitted a wide array of state options with federal approval, but the Clinton administration quietly made it clear that designs of which it disapproved would never receive a waiver. If President Barack Obama is reelected in 2012, it is hard to imagine HHS approving waivers in 2014 that would permit states essentially to gut his health care reform. If a Republican is elected, liberals who envision Wyden–Brown as a step toward a single-payer system are going to be very disappointed.
I suspect Wyden-Brown will pass. I find it encouraging that we’re discussing an alternative that allow states to implement single-payer rather than emoting about repeal and replace.
Here’s Obama’s public statement on Wyden-Brown. I have to say, he comes off sounding a bit too much like a smooth operator, with a delivery that makes one wonder what he’s not saying.
For a more upbeat view of Obama, in connection with the Arab revolutions, see Roger Cohen’s NY Times editorial, “Oh, What a Lucky Man.”
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Image: Boston Globe
Stuart Butler, The Wyden–Brown Bill — Short on State Flexibility, The New England Journal of Medicine, February 3, 2011, 364(5), pp. 397-399
Amy Goldstein and Dan Balz, Obama offers states more flexibility in health-care law, The Washington Post, March 1, 2011
Judy Woodruff interview, President Obama Shifts on Health Care Reform Law for States, PBS NewsHour, February 28, 2011
Marilyn Werber Serafini and Mary Agnes Carey, Wyden: States Will Drive Support For Pre-Emption Bill, Kaiser Health News, December 16, 2010