Sarah Kliff does a brilliant job of explaining how an under-covered piece of “Obamacare” – the Medicaid expansion – was altered by the Roberts Court. The gist? What was a mandate (that word again) on the states, with redistributed government money going out everywhere, is now an option. Republican-governed states can plant the Gadsden flag and swear off compliance. It’s happened before.
I wonder if this moves us toward a resolution of one of the fine, forgotten ideas from the aftermath of PPACA passage. The law, as written, allows states to opt out of the insurance mandate by 2017. The catch: Any state that bails has to prove that it’s providing coverage at least as widely as it would be if it accepted the various mandates. In early 2011, Senators Ron Wyden and Scott Brown introduced a bill that would move the waiver date up from 2017 to 2014. And not long afterward, the White House endorsed the idea. But, well, you know… Congress. When I talked to Wyden yesterday, he talked up the idea but didn’t pretend anything could pass before the November election.
Fast-forward to December, or to 2013. What if the early wiever passes? Well, then states could accept the federal government’s funding – doled out through 2017 – and develop their own coverage regimes. Vermont, which has already set the wheel turning on in-state single payer, gives us the best example of how this would work. Louisiana, whose governor is talking up non-compliance, is mostly giving us a taste of the early backlash. But a waiver is probably a more useful response to this problem than the current “cross fingers, hope Romney and 60 Republican senators get sworn in” response.