Here’s Ezra Klein on Obama’s statement yesterday on allowing states to depart from the federal plan for the state exchanges:
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. 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.
I think it’s great that Vermont will move forward on single-payer, and Oregon will go further than the PPACA. But I live in a state (presently) run by conservatives, so, substantively, this is the important part for me:
implement an alternative policy so long as it accomplishes the law’s basic goals
I’ll refer back to an earlier post on Mitch Daniels’ Healthy Indiana for a primer on how a conservative governor might go about paying more for less health care:
providers serving Healthy Indiana beneficiaries have indeed been paid more than they would have if the beneficiaries had been covered under Medicaid. However, Healthy Indiana covers only about 44,000 Indiana residents, while more than 830,000 Indianans are uninsured. And in order to pay for the 44,000 Indianans in the Healthy Indiana Plan, the state took $50 million from funds that it uses to help reimburse hospitals for uncompensated care. In other words, 40 percent of the state’s uncompensated care funds were spent on only 5 percent of Indiana’s uninsured population.
Unfortunately, neither premise is correct. Healthy Indiana’s waiting list is longer than the number of enrollees it has. And uninsured Indianans, whether eligible for Healthy Indiana or not, continue to need health care. Meanwhile, for those actually in the program, the state paid $75 more per month in 2009 for the healthiest group of Healthy Indiana enrollees than it did for comparable adult Medicaid beneficiaries, even though Healthy Indiana beneficiaries are ineligible for many expensive services, such as maternity care, that Medicaid beneficiaries receive. That doesn’t include the cost that Healthy Indiana beneficiaries must pay out of their own pockets: up to $1,100 per year.
There is no evidence that Healthy Indiana beneficiaries are getting better care than Medicaid beneficiaries. However, the care they are receiving costs more, and leaves less for reimbursing uncompensated care for the remaining 95 percent of the uninsured.
A Commenter at Balloon Juice (formerlyThe Grand Panjandrum)
Vermont Governor Peter Shumlin was thrilled that the President was amenable to states finding solutions that fit their situation better.
Using the Affordable Care Act as a floor and allowing states to find even more cost effective solutions makes sense. But I personally think that Republicans know that by giving ground here the debate is over. It is not a matter of if, but when near universal coverage becomes a reality. Imagine how much of a competitive edge a state will have if health care costs are stabilized? Knowing the cost of business for the foreseeable future is a very important and persuasive argument for when deciding on where to locate – or relocate – a business. Why do you think Toyota and Honda have both chosen to build new assembly lines in Canada over the southern US? The southern US has a more favorable tax climate, BUT the automakers looked at the workforce skill set and the cost of health care. Game over. Canada won.
Bulworth
Of course opposition to the ACA isn’t driven by state officials just beside themselves with rage and disappointment that because of the ACA they won’t be able to implement their super duper great full coverage plans. The opposition is driven by state officials and teabaggers who want to cut coverage.
Martin
I haven’t heard any recent rumblings about single-payer in CA – that’s mostly on the back burner until the budget gets hashed out, but I expect it to be taken up soon thereafter. Dems passed it out of the legislature only for Arnold to veto it. We’ve got more Dems in the legislature now than then, and a Dem governor, so as long as it’s cost effective, I can’t imagine it won’t make it this time.
kay
@Martin:
This is pie in the sky and down the road a ways, but I’d love to see the competitive advantage of a state with single payer versus one with a crappy Healthy Indiana-like system.
I think you win, Martin. Jobs, jobs, jobs, as they say :)
piratedan
or you can use Arizona’s model and simply kick all of the poor folks off of the existing state program that need transplants……
chopper
it’s as if obama is trying to knock out romney’s chance of winning the GOP nod. which is nice.
The Republic of Stupidity
@Bulworth:
There…
Better… no?
The Republic of Stupidity
Woo hoo!
Less coverage at a higher cost…
The invisible hand of the market place, working its magic in Indiana…
joe from Lowell
@chopper:
Funny you should mention that. Patrick Lauds Romney for Health Care Law. Just this pasty Sunday.
Yutsano
Hmmm…I may have to check how bad the commute from Vermont to Andover MA is. If it’s manageable I could transfer. And I may haz mad jelus of debit if Vermont actually makes this happen. And if CA and VT jump, I wonder if we can make WA next in line. Of course that’ll take an income tax and our guv gaining balls, so I’m not too optimistic.
danimal
If the GOP keeps its’ rhetoric while opposing Wyden-Brown, the Dems should push the bill and make the GOP filibuster it. Their explanations would be priceless.
daveNYC
I’d love to see NY get in on this, but our Republicans are chock full o’crazy. There’s a better chance of NYC passing single payer than of the state getting it done.
Cacti
I think the plan in Arizona is to declare the uninsured non-citizens.
Rick Massimo
Yeah, there’s the rub. GOP governors are going to write a “policy” that’s basically “let the free hand of the market work this out so we can keep the greatest healthcare system on Earth” and then say “It accomplishes the law’s basic goals because SHUT UP SHUT UP SHUT UP YES IT DOES.”
soyaki
“Indianans”? Come on. It’s Hoosiers.
Bulworth
@The Republic of Stupidity: Yes. I stand corrected.
eemom
here in Virginia, I expect everyone who gets sick to be hit with a Kookinelli subpoena.
Rick Massimo
P.S.: I remember when the Homeland Security Department was established and the small-government conservatives demanded that each state be allowed to set their own anti-terrorism policies because they know best, rather than some out-of-touch, tyrannical bureaucracy in Washington, D.C.
Oh, wait – that was under the white guy, so that didn’t happen.
Triassic Sands
@Yutsano:
Not too optimistic? I don’t see anything good happening in WA until Gregoire is gone. “Balls” aren’t on the menu, she lacks character and is a classic Democratic invertebrate, who is incapable of leading, because that would require 1) that she take a stand and 2) that she expend political capital. Neither is characteristic of Gregoire. She is the classic space occupier, comfortable running off to Asia to schmooze and push trade, but utterly unwilling to take even the slightest political risk for the benefit of her constituents.
When she delivered her “all cuts” budget she called some of the cuts “immoral,” but she’s more comfortable backing immoral budget cuts than she is fighting for anything progressive. She’s a terrible governor, and not much of a human being.
If all that stands between WA and a single payer system is an income tax and Gregoire acquiring some backbone, I’d rate the chances of single payer at zero or slightly less.
joe from Lowell
@Rick Massimo:
And then the electorate in their states gets to judge them on their performance.
gwangung
More the former than latter. If an income tax was possible, Gregoire would go for it. Since it isn’t, why bother tackling an impossible task?
Zifnab
@Rick Massimo:
They basically had this fight in Texas already, when it came to clean air standards. Perry would stomp his feet and whine that Texas does too have clean air. And the state would get a waver from the EPA to keep on pumping out coal fired air pollution.
Once the Republican governors have finished coming up with forty million reasons why the law is Unconstitutional, it’ll be on to forty million reasons why the status quo does to insure exactly as many people as the ACA mandates.
dcdl
Oregon Single Payer Campaign is rallying at noon Friday, March 11, 2011 at the State Capitol to support HB3510 and SB888.
Triassic Sands
One key to Republican thinking about health care is that it is an immutable zero sum game.