President Barack Obama announced support for the Weyden Brown proposal to give state more flexibility in how they implement the Affordable Care Act.
Current law limits the ability of states to develop their own solutions to health care coverage until 2017. Obama’s move is seen as an effort to counter initiatives in several states that are resisting aspects of health care reform. Some states oppose the individual mandate, and some state resist the added burden of expanding the Medicaid roles. But some states, most notably Vermont are moving in the exact opposite direction with popular movements in support of a statewide single payer system.
During last years long drawn out debate leading up to health care reform, the Obama administration resisted bi-partisan efforts to give states more flexibility to develop their own solutions. Does he now realize the error of that stance?
wrote for Kaiser Health News and The New Republic
The actual change Obama proposed is, to be sure, modest. Under the Affordable Care Act, states are responsible for creating exchanges (the marketplaces where individuals and small-businesses can buy coverage) as well as implementing other key aspects of reform. That work must be done by 2014. The law allows states to opt out of the scheme, by getting a special waiver from the federal government, as long as they have alternative means for achieving the measure’s mandated goals. But states can’t do that until 2017….
And yet, as the conservative critics note correctly, the flexibility would have limits. The administration made clear that states could opt out of the health law’s requirements only if they could show they would insure at least as many people, providing coverage that was at least as comprehensive and at no greater expenses to the taxpayers…
But couldn’t conservative alternatives achieve the same goals for less money? Not really. Most of the ideas that conservatives like to promote would, at best, expand insurance coverage very modestly — and, in many cases, only by making coverage less comprehensive…
None of which is to say there aren’t better, more efficient ways to achieve universal coverage. Vermont lawmakers want to create a single-payer plan — that is, a government-run insurance program, similar to Medicare. They would probably among the first to apply for a waiver if Wyden-Brown became law. And they’d probably get it, because most estimates suggest a single-payer could satisfy Obama’s criteria: Covering as many people, with the same or better financial protection, for similar or even lower costs. But, of course, that’s not the sort of health care alternative conservatives have in mind.
States such as Vermont and California, which appear to be closer than any others to enacting a state single-payer health system, welcomed the president’s support for the Wyden-Brown amendment because it would remove one of the many barriers they face. The amendment will still need to be passed by Congress before it arrives at the president’s desk, which may in itself be a formidable feat in the current political climate.
In addition, for states that want to take the path of single payer, even with the amendment, there will still be many hurdles before they can implement such a plan. The amendment only moves up the date when waivers can be applied for. It does not guarantee federal approval of the many waivers a state single-payer system would need, such as being allowed to roll their Medicaid and Medicare populations into their single-payer system….
Of concern is that the president is signaling a greater willingness to allow states to opt out of the health reform bill not because states want to provide better coverage but because governors in some states are opposed to the federal health law altogether. …
While some welcome the president’s support for the amendment and hope that if it passes a state will be able to demonstrate the benefits of a single-payer system, as happened in Saskatchewan (and which led to Canada’s national Medicare system), it is possible that the actual outcome of such an amendment will be a further attack on our necessary public health programs. For this reason, it is imperative that we continue to push for a national health program, improved Medicare for all in the U.S.