The Insider: The Politics of State Flexibility
What’s behind the President’s embrace of state flexibility? President Obama surprised a lot of people, including, apparently, Congressional Democrats, when he came out in favor of moving up the date when states could seek “global waivers” under the Affordable Care Act to craft their own health policy solutions. The waiver provision in the ACA, which would let states opt out of the Individual Responsibility Requirement (IRR), the Exchange and other provisions of the law as long as they can provide coverage that is equally comprehensive, equally affordable and doesn’t add to the federal deficit, goes into effect in 2017. The President announced his support for moving that date up to 2014. Republicans lost no time in trashing the President’s announcement. At the same time, there was conspicuous silence from Congressional Democrats, suggesting there is little chance a waiver date change could move through Congress.
There are also some technical challenges to implementing a waiver in advance of establishing any baseline for coverage or spending, but the President’s support for changing the date should be viewed through a political rather than policy lens. It was more designed to change the conversation about health care reform than to change policy.
Republicans have generally concentrated their fire against the means in the ACA rather than the ends. By declaring his support for greater flexibility over the means, President Obama is challenging Republicans to come up with an alternative that will work as well as the ACA or, failing that, forcing them to admit that they do not support comprehensive affordable coverage for all Americans.
Support for greater state flexibility also creates some daylight between the President and the IRR, which is probably the least popular provision in the ACA. At the same time, it creates some tension between Congressional Republicans and Republican governors. While the governors have been largely on board with the Congressional repeal strategy, if push comes to shove and they really do have to implement the ACA, they’d rather have more flexibility. For Congressional Republicans, however, any move to “fix” the ACA would blunt their attack messages and so must be rejected out of hand.
Since there is no sign that Democrats in either branch are interested in pursuing the idea, “state flexibility” could be a one-day blip in the 24/7 news cycle, but don’t be surprised to see it return as a talking point as the Presidential election gets closer.
That Settles That (for the moment) For all those wondering whether Judge Vinson’s ruling that the entire ACA must be struck down because the IRR is unconstitutional halts implementation of the law pending appeal, the answer came down last week—it doesn’t. However, in an effort to speed final resolution, the Judge demanded that the Justice Department speed its appeal to either the 11th circuit or directly to the Supreme Court. The main effect of the judge’s ruling is that is should tamp down state resistance to implementation. For a scary look at the legal reasoning that underpins the challenges to the ACA and the consequences if that reasoning was widely applied, check out this issue brief by Simon Lazarus at the American Constitutional Society for Law and Policy.
Good news for beneficiaries/ bad news for millionaires New poll results show the American people do not want to see cuts to Medicare and Medicaid and generally do not believe that such cuts are necessary. In fact, cutting Medicare and Medicaid are among the least popular options for dealing with the budget deficit. Most popular approaches are raising taxes on the wealthy, eliminating unnecessary weapons systems and reducing tax subsidies for the oil industry.
— Michael Miller, Policy Director