Health Reform: Covering State Opt-Outs And The Next Big Battle

President Obama's support for a bill that would let states opt out of national health reform mandates early to come up with their own plans has been described variously as "a bomb," a "major concession" to reform's critics, or "calling the Republicans' bluff."  

But is it any single one of these things? Not so much. Here's some context and a look at some analysis of Obama's highly-publicized support for the Wyden-Brown state waiver bill, which he announced to the nation's state governors on Monday.

As Sheryl Gay Stolberg and Kevin Sack point out in the New York Times, it would be tough for states to come up with substantial enough reforms, whether they involve a single-payer system or free-market incentives, to insure as many people and as comprehensively and as affordably as federal health reforms are intended to. They'd have to convince federal regulators they could do so before they could get a waiver to opt out of national health reform requirements. In fact, Stolberg and Sack write:

the prospects for the proposal appear dim. Congress would have to approve the change through legislation, and House Republican leaders said Monday that they were committed to repealing the law, not amending it. Even if the change were approved, it could be difficult for states to meet the federal requirements for the waivers.

Ken Terry, who writes the Critical Condition healthcare blog for BNET, does think that Obama's support for the Wyden-Brown bill "could shake up the healthcare debate,"  while  noting that Republican reaction ranged from "guarded to negative."

The Republicans are not about to be forced to come up with a workable alternative to Obamacare. But by giving them the opportunity to do so, Obama has improved his political position: his opponents can no longer say that the Democrats are forcing them to do exactly what's in the Affordable Care Act.

Writing for Kaiser Health News, Jonathan Cohn notes that critics of the Wyden-Brown bill have a point – that it wouldn't allow states true flexibility in coming up with their own reforms:

But that's because their proposals wouldn't come even close to making health care affordable for all Americans. The real problem here, in other words, isn't the lack of flexibility in the health law. It's the lack of workable ideas from critics on the right.

For health journalists at local and state levels, the opt-out issue is primarily a Beltway political story – one that's likely to be overshadowed soon by the next big battle over health reform: how health reform's Medicaid expansion will affect already-strapped state budgets. And that's an issue we all should be watching closely.

We'll have more on covering Medicaid and health reform at the state and local levels in future posts. In the meantime, check out Joanne Kenen's comprehensive piece for Miller McCune on legislative tactics that may be used to block implementation of health reform.

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