I think the Wyden Waiver Watch will become a personal hobbyhorse. Wyden Waivers are also known as Section 1332 waivers and State Innovation waivers in the Affordable Care Act. They allow states to significantly change PPACA’s implementation for the state’s residents as long as the changes result in the same or higher levels of coverage for the same or more people at no greater cost to the federal government than the current system.
If Republicans were interested in healthcare policy and thought that their ideas were superior, this would be an opportunity to not pass up. Wyden waivers go live on January 1, 2017. From a plumbing point of view, states that want to go the Wyden waiver route need to start formulating rough plans now with final details going in late this year or early next year.
The AP has a piece on Wyden Waivers that is somewhat depressing:
Riley said so far there is interest in the waivers among state officials in Hawaii, New Mexico, Minnesota and Vermont.
Vermont is not a surprise, they were initially planning to use a Wyden waiver for single payer, and after they took single payer off the table, they are still interested in significant healthcare financing and delivery reform. Minnesota has been probably the most active embracer of all of the voluntary programs in PPACA as they were the first state to start a Basic health care plan for people who make up to 200% FPL. The Basic plan is a block grant from the Feds to cover people up to 200% FPL instead of putting them on the Exchanges. Hawaii is slightly interesting, but they have a Democratic trifecta with super-majorities in the Legislature. I can see a demand for innovating coverage expansions.
New Mexico is the only state showing interest which is not a usual suspect. It has a Republican governor and lower chamber and a Democratic Senate. It is a state where there are disputes on the nature of medical coverage and social welfare spending plays out at the government level. I would have hoped that several other states would have been interested in more local control and autonomy to play to their political policy preferences of localism instead of centralism while expanding coverage, but we’re not seeing that.
Punchy
Presidential Inauguration sometime in mid-Jan….so these’ll be in effect for about 2 weeks before the whole thing is scrubbed by the GOP President and his Congressional minions. Unless SCOTUS gets there first….
Yes, pessimism rules the day w/rt/ the ACA and this political climate.
raven
@Punchy: Whatever
japa21
Many of those states you would like to see are against the whole idea to begin with. They are also the states that most demand the feds stay out of their business.
As you say, in a logical world, Republicans should be thrilled to see what they can come up with. But doing so would be accepting that the basic principles of the ACA are okay, and they would rather have their testicles cut off with a rusty spoon than to admit that.
Nutella
More evidence that the people who are always shrieking “state’s rights!!” don’t really want state’s rights at all. What they really want is far-right policies enforced by any and all levels of government and society but they like to dress it up with pretty labels.
RaflW
This statement needs to be widely circulated. All the Broderists in our national media need to have this statement shoved up their … uhh … inboxes. Because as we who pay attention know, the GOP is not interested in policy. They are not interested in healthcare outcomes for their voters. They are not looking for better solutions.
They are seeking power only to enrich their masters. Period.
And things like the Wyden Waiver make that as plain as a zit on Boehner’s nose. Not that our press could be bothered to see or say anything.
(I think it also shows that at least some Republicans know that their purported ‘solutions’ are not actually useful and do not want them subjected to the harsh light of scoring and analysis required to get a waiver).
Roger Moore
@RaflW:
ITYM they know that Obama’s HHS would never give them a fair scoring, so there’s no chance they’ll ever get their waiver. Obama clearly doesn’t believe in magic pixie dust.
Ryan
Actually, Arizona appears to be doing the opposite. Very sad.
Ella in New Mexico
Whore for any and all Republican support that she may be, Susanna Martinez was no dummy when she accepted Federal funding and set up the exchanges. New Mexico is far too poor and far too Democratic to have turned it down.
However, I have absolutely no faith that she or her advisers have good faith intentions in seeking a Wyden Waiver for our ACA funding. She cares NOTHING about innovation or quality in services–she is DESPERATE to move up the Republican food chain and has a right hand adviser who’s sole job is to see to it that her decisions and actions make her VP or Cabinet material.
Her track record with the state’s community mental health providers, has proven that she is not only pretty dumb, but ruthlessly self-interested in any opportunity to use state funding to repay potential big donors and political supporters. There is good reporting being done by a couple of our newspapers and state blogs that she appears to have received donations through a spiderweb of large contributors and subsequently paid for a “Medicaid Fraud Audit” by a firm who’s questionable report then justified her shutting down over 15 local mental health providing organizations that had been doing good work for decades, and handing the no-bid contract for their operations to an Arizona company tied to United Health Care–the company that owns the audit firm.
Story is still in progress, but like I said, I really hope Martinez and her corrupt little clique in Santa Fe will have minimal discretion as to how a large block grant from the Feds would be used.
http://nmindepth.com/series/medicaid-freeze/
http://www.sfreporter.com/santafe/article-10097-access-peak.html
Kylroy
@Ella in New Mexico: Given her national GOP aspirations, I’m kinda stunned she accepted it at all. I could see a state-focused GOP pol deciding the opportunities for grift and favor trading outweigh the shrieks fro mthe Tea Party, but unless something changes any Republican who broke bread with Obamacare will be seen as a traitor by a substantial chunk of the primary voting populace.
Ella in New Mexico
@Kylroy: Not in the circles she’s running in. She pretty much expects a Jebby Presidency, and is seeking favor with R’s who want that too. Those types here are less worried about Obamacare-they’ll forgive that trespass. :-)
Elizabelle
@Punchy: Comments like this is why I am not on this blog as much any more.
Tired of the unrelenting pessimism and “eh, there’s a thundercloud in here somewhere” ethos by some here. It’s pervasive sometimes.
Not calling you out so much personally, Punchy, as to let you know how despairing it is to read shit comments like the first one up on this thread.
And they wonder why some Democrats don’t vote as much.
Davis X. Machina
That’s not much of an attractor if you actually want to cover fewer people, or provide lower levels of coverage, than the present system, now is it?
Punchy
@Elizabelle: OK, fine. The ACA will be fine via a 6-3 SCOTUS vote and should a GOP President cheat his way in, I’m sure he’ll recognize the huge bennies the ACA provides and agree to stick with Obamacare despite the GOP House and Senate majorities.
Better?
richard mayhew
@Davis X. Machina: But there are opportunities for some serious grifting… The waiver is funded by a federal block grant to the state that is the sum of premium assistance tax credits, cost sharing reduction cost sharing, and small employer tax credits. It is a big chunk of change is the challenge is to do it better for cheaper and what happens to anything left over is up to the state.
if I was designing a Wyden waiver to maximize grift opportunities, I would design a public option with Medicaid like pharmacy benefits (cost per service paid drops by 15% to 25% immediately), very narrow networks where the goal is to get the hospitals to give big campaign contributions to me to get included in the preferred tier, and then secondary support services where I can hire all of my hacks to synergize and strategize with some of the leftover… and then the rest is tax cuts for the job creators
jl
@richard mayhew: Thanks for informative and useful posts today.
But in that comment, you trolling for some read state waiver applications with your handy dandy tips for ‘honest graft’ opportunities? Well, if it works it works, I guess.
Ella in New Mexico
@richard mayhew:
Exactly my pessimistic view about why I hope NM doesn’t do this right now under Martinez.
Kylroy
@Ella in New Mexico: I think the key difference is that she is eyeing appointed positions over elected ones. Money Republicans could give a shit about ideological purity, and they’re still the ones who decide cabinets.
piratedan
@Ryan: It’s because they elected a guy who was bought by the Koch Brothers… wholesale. This state is one of those places where there’s enough sanity to get your hopes up and then watch them shattered on the floor like a rampaging toddler that’s gone napless for a month….
jharp
I called my state representative today and the dumbfuck who took my call tried to tell me that Canada’s health care system is socialized medicine. And that every other country who covers all of citizens too uses socialized medicine.
And no. He had no clue of the existence of the Wyden Waiver.
This is from the same group that spent the past several weeks passing the Religious Freedom Restoration Act.
Gotta have your priorities in order I guess.
Ugh! Can’t wait to get out of this hellhole.
Richard Mayhew
@Ella in New Mexico: I’m okay(ish) with relatively honest grifting as long as the underlying policy goals (covering more people as well or better than the ACA covers them at the same or lower total costs) can be achieved. I don’t have an overwhelming objection to sausage making as long as sausage is actually produced and tastes good and is filling.
Ella in New Mexico
@Richard Mayhew:
Agreed, but like I said above, our governor’s discretion over our mental health system has resulted in terrible consequences for those who need it the most. New Mexico has some of the worst mental health statistics in the nation, combined with lots of low income people in rural areas with no resources to obtain decent services who depended on non-profits to meet their basic needs. Now we have an actual crisis here, that is hurting real people everyday, all for political patronage. And the mental health system mirrors our healthcare system.
Under Richardson, we had “sausage”, too, but the benefits were shared. Under unscrupulous and callous leadership, with no balancing of stewardship, this waiver could result in a return to pre-ACA chaos and lack of proper coverage for our most vulnerable populations.
fuckwit
Well, duh. The R’s have no intention of doing public policy. Is this not obvious by now? Why is this even a point anymore?
The R’s are a nihilistic, apocalyptic cult dedicated to the destruction of all government except the military.