• It depends what you mean by “flexible”

    I’m seeing lots of noise and getting lots of email about President Obama’s decision to endorse Wyden-Brown. Me, I’m just having trouble saying “Wyden-Brown” and not “Wyden-Bennett”, but that’s my issue:

    In remarks to the National Governors Association, Mr. Obama said he backed legislation that would enable states to request federal permission to withdraw from the law’s mandates in 2014 rather than in 2017 as long as they could prove that they could find other ways to cover as many people as the original law would and at the same cost. The earlier date is when many of the act’s central provisions take effect, including requirements that most individuals obtainhealth insurance and that employers of a certain size offer coverage to workers or pay a penalty.

    “I think that’s a reasonable proposal; I support it,” Mr. Obama told the governors, who were gathered in the State Dining Room of the White House.

    “It will give you flexibility more quickly while still guaranteeing the American people reform.”

    The announcement is the first time Mr. Obama has called for changing a central component of his signature health care law, although he has backed removing a specific tax provision that both parties regard as onerous on business. The shift comes as the law is under fierce attack in the courts and from Republicans on Capitol Hill and in statehouses around the country.

    I’m seeing a number of takes on this.  Such as (1) that this is an abandonment of the individual mandate. Others are saying that (2) this is the President admitting that there are problems with PPACA and acknowledging that change is needed. And, finally, I’m hearing from people who think (3) that conservative governors should now be happy because they will get the ability to ignore PPACA and go their own way if they want to.

    I think, unfortunately, all that is wrong.

    All of this hinges on this important caveat of Wyden-Brown:

    The legislation would allow states to opt out earlier from various requirements if they could demonstrate that other methods would allow them to cover as many people, with insurance that is as comprehensive and affordable, as provided by the new law. The changes also must not increase the federal deficit.

    And therein lies the issue. As for (1), if states can accomplish this caveat without an individual mandate, more power to them. Won’t happen unless they radically change the implementation.

    That brings us to (2). President Obama is conceding little here. If states can come up with systems that meet the caveat, they are likely to be more progressive than the PPACA. Vermont’s single-payer system, for instance. Most conservative plans for health care reform won’t be able to meet the “as comprehensive” caveat.

    Which is the whole point of (3). States like Indiana want to be able to offer less comprehensive insurance (which would be cheaper), but that’s not what Wyden-Brown allows. So there’s no way this will meet the demands of many Republican governors who don’t want to implement PPACA, let alone something more progressive.

    I’m not saying the President’s move isn’t good politics. It may be (or may not be). But I don’t think it’s going to change the administration’s support of PPACA, nor mollify those who oppose it from the Right. Nor should it.

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