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Posted at 12:24 PM ET, 02/28/2011

White House comes out for Wyden-Brown state waiver program

By Ezra Klein

scottborwnwyden.JPG

The White House's fact sheet here. For more on Wyden-Brown, which lets states receive money from the Affordable Care Act but implement an alternative policy so long as it accomplishes the law's basic goals, read this. Here's my interview with waiver supporter Bernie Sanders on the subject.

The question is whether this makes Wyden-Brown more or less likely to pass. I'm guessing less likely. The political theory behind Wyden-Brown was that it gave Republicans a constructive way to attack the Affordable Care Act: The waiver program could be sold as a critique of the law -- "it's such a bad bill that states need to write their own policy" -- even as it entrenched the country's basic commitment to universal health-care insurance. You could've imagined it being attached to the budget or one of the spending bills as part of a larger bargain.

But now that Obama has admitted it's not a threat to the Affordable Care Act, a lot of the appeal for Republicans dissipates. Supporting it could even be seen as helping the White House in its efforts to defend the law against repeal. So the idea looks likelier to become a talking point for the administration -- see how reasonable we're being? -- than an outlet for Republicans. But perhaps that doesn't matter: Wyden-Brown hasn't attracted any Republican co-sponsors beyond Scott Brown, so maybe it never had a chance of playing its intended part anyway.

Photo credit: AP Photo/Harry Hamburg.

By Ezra Klein  | February 28, 2011; 12:24 PM ET
Categories:  Health Reform  
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Comments

Not sure I agree (depending on the details on how devolution/waiver process is constructed). There are existing federalist models in environmental law -- SMCRA comes to mind. Devolution w/federal approval and oversight was key to getting it passed. I also think that healthcare advocates often stand a better chance keeping pressure on state legislators than federal over the long haul.

Posted by: lenstewart1 | February 28, 2011 12:37 PM | Report abuse

The Republicans would look very petty if they oppose this very reasonable and flexible idea. This is a win-win for everybody. These are the kind of things independent voters look at and applaud. They want to see constructive compromises. The President looks like an adult in the room. Sen. Brown looks like an adult in the room.

I really think if the Republican leadership opposes such a sensible idea, it would damage them politically in the short and long term. The current GOP is increasingly becoming a party of doctrinaire ideologues.

Posted by: jasonr3 | February 28, 2011 12:40 PM | Report abuse

The more they take actions like this, the more they bolster the GOP argument that the legislation was a mistake.

Furthermore health care may be the only field where we try to argue that making conditions more fragmented, more byzantine, and less responsive to market conditions nationwide, will lead to a better product at a lower price.

Posted by: johnmarshall5446 | February 28, 2011 12:50 PM | Report abuse

This could be a good thing. It might provide states with flexibility to deal with state-specific issues. I also think governors and state officials are more responsive to the desires of voters in that state. A few people upset in Rhode Island won't change a national law, but they can probably get changes to a state law.

It also might take some steam out of Mitt Romney's stance of how his Health Care mandate was good on the state level, but how its bad at a Federal level.

Since "conservatism" seems to be now be defined as "the opposite of whatever liberals support, to be updated daily," I doubt we'll see too many people in the GOP see it as a reasonable course of action now that Obama has said its ok with him.

Posted by: Nylund154 | February 28, 2011 12:59 PM | Report abuse

This is the administration making a political argument, not a policy argument, and I think it's a good strategy when viewed in this context. That it happens to also be good policy while having a marginal impact on the original legislation is gravy.

Take Mitt Romney's position. His overarching defense of Massachusetts HCR (and specifically its individual mandate) is that the states, and only the states, have the right to impose such requirements.

Now, Obama has endorsed an amendment, sponsored by both a Democrat and Republican, that accelerates the timetable for states to create their own version of HCR with much less "interference" from the federal government.

Accordingly, he can credibly argue that he's willing to work with the GOP to allow them the very thing they claim to want most - autonomy from Washington - while simultaneously damaging their brand, since they will inevitably pounce and claim the legislation is flawed and needs to be repealed.

This is important, since it provides a distinction between Obama and the Democrats versus the GOP; one group is willing to collaborate, while the other is not. And polling, particularly of self-identified independents, make it clear that cooperation and bipartisanship is important.

Posted by: The_Doc1 | February 28, 2011 1:14 PM | Report abuse

*****Supporting it could even be seen as helping the White House in its efforts to defend the law against repeal.*****

COULD EVEN? Ezra, buddy, you've got to be kidding me. OF COURSE it will be viewed that way. What part of "The Tea Party is miltantly opposed to all and any expansions of social insurance" don't you get? They take their cues from Ayn Rand, and therefore so does, these days, the Republican Party as a whole.

The enactment of Wyden-Brown would ensure the survival of the PPACA, and it therefore won't find the votes in either chamber. I think your wishful thinking/optimistic nature has interfered with the cynicism required these days for any realistic view of US policy making.

(Mind you I hope I'm wrong!).

Posted by: Jasper999 | February 28, 2011 1:28 PM | Report abuse

Ezra,
Also this is unlikely to pass because it would hurt GOP governors, who are presently the main source of presidential hopefuls for the GOP. Currently, they are able not do anything with regards to the ACA and then blame "federal bureaucrats" for implimenting the law within their state. Brown-Wyden would put the ball in their court and force the governors to do something. The more similiar that "something" is to ACA, the more the governors are hamstrung during the primary.

Posted by: ctown_woody | February 28, 2011 1:42 PM | Report abuse

What states really need is flexibility in not having to achieve some partisan goals.

Posted by: krazen1211 | February 28, 2011 2:17 PM | Report abuse

The road to single payer goes through state-level experiments.

Posted by: willows1 | February 28, 2011 2:23 PM | Report abuse

Furthermore health care may be the only field where we try to argue that making conditions more fragmented, more byzantine, and less responsive to market conditions nationwide, will lead to a better product at a lower price.

Posted by: johnmarshall5446 | February 28, 2011 12:50 PM

How? This is a very good idea that as some others have said the Republicans had better latch onto. Fragmentation only makes it more complex, more costly.

Posted by: visionbrkr | February 28, 2011 2:34 PM | Report abuse

Seriously, what is Obama thinking? Supporting this does absolutely nothing for him, but gives away the best way for the GOP to constructively oppose ACA.

Posted by: Chris_ | February 28, 2011 2:59 PM | Report abuse

Seriously? No one is excited for single payer in Vermont and a public option in Oregon? Cause that's what we get if this bill passes.

Then again, if it doesn't, we'll just have to wait till 2017.

Posted by: CarlosXL | February 28, 2011 3:01 PM | Report abuse

How is this any different from the ability to apply for 1115 waiver that already exists?

The 1115 waiver allows states flexibility to see if they can do things better so long as the goals of medicaid are still met.

Posted by: youwillfindchris | February 28, 2011 3:04 PM | Report abuse

--------------
I really think if the Republican leadership opposes such a sensible idea, it would damage them politically in the short and long term. .----------------

You're wrong. This idea allows for states such as California, Vermont, Mass and many others to implement Single-payer health care systems. Single-payer is vastly superior to anything America has. Allowing states to implement single-payer only adds to the ever increasing evidence that government action is beneficial, and that conservative ideology is anit-reality, therefore hurting Conservatives.

Posted by: mynameisblehbleh | February 28, 2011 3:14 PM | Report abuse

vision:

I don't understand your comment. This IS fragmentation, allowing each state to pursue health care in it's own way. Imagine if car manufacturers for instance were not allowed to sell across state lines, and had to comply with different manufacturing requirements in each state. How about if GEICO had to set up GEICO Maryland, etc?

Posted by: johnmarshall5446 | February 28, 2011 3:15 PM | Report abuse

Critics of the ACA can't have it both ways; on one hand saying it's a burdensome, top-down, one-size-fits-all approach that denies states their right to create their own insurance systems, and then oppose this change because some states like VT might choose to become single payer.

Posted by: matthat121 | February 28, 2011 3:25 PM | Report abuse

The White House should adopt a policy of supporting/opposing legislation inversely proportionate to how much it actually wants the legislation to pass and call it the Briar Patch Doctrine.

I'm not sure if I'm joking or not.

Posted by: Porchland | February 28, 2011 3:37 PM | Report abuse

matthat121 - "Critics of the ACA can't have it both ways"

Oh yeah? Just watch 'em.

Posted by: willows1 | February 28, 2011 4:05 PM | Report abuse

@johnmarshall

My bad. I misunderstood your post. We agree

Posted by: visionbrkr | February 28, 2011 6:10 PM | Report abuse

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