Give The Public What They Want, More Blog Posts On Mandates

Sheryl Gay Stolberg and Kevin Sack at NYT:

Seeking to appease disgruntled governors, President Obama announced Monday that he supported amending the 2010 health care law to allow states to opt out of its most burdensome requirements three years earlier than currently permitted.

In remarks to the National Governors Association, Mr. Obama said he backed legislation that would enable states to request federal permission to withdraw from the law’s mandates in 2014 rather than in 2017 as long as they could prove that they could find other ways to cover as many people as the original law would and at the same cost. The earlier date is when many of the act’s central provisions take effect, including requirements that most individuals obtain health insurance and that employers of a certain size offer coverage to workers or pay a penalty.

“I think that’s a reasonable proposal; I support it,” Mr. Obama told the governors, who were gathered in the State Dining Room of the White House.

“It will give you flexibility more quickly while still guaranteeing the American people reform.”

Kate Pickert at Swampland at Time:

As I wrote in November, there’s no guarantee Republicans governors will embrace this 2014 opt-out waiver plan, which would have to pass through Congress to become law:

Aside from the political implications of endorsing a plan championed by a Democratic leader on health reform – even if he is in cahoots with a Republican from a blue state – some on the right might balk at the Wyden-Brown plan on the grounds that it’s still an expensive expansion of government. The Wyden-Brown plan, after all, does not – as far as I can tell – spend any less money than the ACA without a state opt-out. On the contrary, it may cost more.

The Wyden-Brown plan also does not impact the huge Medicaid expansion called for in the ACA, which Republicans vehemently oppose. It doesn’t eliminate taxes on expensive health insurance plans, or fees levied on medical devices or pharmaceuticals.

Another catch: The Wyden-Brown plan only allows states to opt out if they have a good plan for how to undertake comprehensive health care reform on their own. Most states don’t have such a plan. Massachusetts, which enacted reform in 2007, obviously does, which is why Brown was a logical co-sponsor of the opt-out bill. California, Connecticut and Vermont are three other states that are on their way toward developing health care reform inside their borders. But red states – especially southern states – are among those least equipped to design and implement reform that could accomplish what the ACA attempts to do, as they typically have higher percentages of uninsured residents and looser insurance regulation.

Conn Carroll at Heritage:

As long as the HHS Secretary, whether it is Kathleen Sebelius or the next occupant of the office, has the final say on granting Obamacare waivers, then there is no real flexibility for states under Obamacare. All 50 of them would still be at the mercy of the whim of the HHS. The only real way to give states true flexibility on health care reform begins with the full repeal of Obamacare.

UPDATE: Politico confirms that Wyden-Brown has nothing to do with offering Obamacare critical states “flexibility” and everything to do with advancing single payer health care:

[A] White House conference call with liberal allies this morning says the Administration is presenting it to Democrats as an opportunity to offer more expansive health care plans than the one Congress passed.

Health care advisers Nancy-Ann DeParle and Stephanie Cutter stressed on the off-record call that the rule change would allow states to implement single-payer health care plans — as Vermont seeks to — and true government-run plans, like Connecticut’s Sustinet.

The source on the call summarizes the officials’ point — which is not one the Administration has sought to make publically — as casting the new “flexibility” language as an opportunity to try more progressive, not less expansive, approaches on the state level.

“They are trying to split the baby here: on one hand tell supporters this is good for their pet issues, versus a message for the general public that the POTUS is responding to what he is hearing and that he is being sensible,” the source emails.

Ezra Klein:

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.

Kevin Drum:

I suspect this is not as big a deal as it seems. Basically, Obama is calling the bluff of Republicans who insist that they can build a healthcare system that’s as extensive and affordable as PPACA using some combination of tea party-approved “free market” principles. He’s telling them to put their money (or, rather, money from the feds) where their mouths are, which will probably demonstrate fairly conclusively that they can’t do it. It’s possible that a state like Oregon might enact a more liberal plan that meets PPACA standards, but I doubt that Alabama or Tennessee can do it just with HSAs and high-deductible health plans.

Still, we’ll see. This is a chance for conservatives to show that they have a better healthcare answer in the real world, not just as talking points at a tea party rally. Obama is betting they’ll fail, and he’s also betting they’ll tear each other apart arguing over details while they do it. Life is easy when all you have to do is yell “Repeal Obamacare!” but it gets a lot harder when you have to produce an actual plan.

Rahm Speaks To The Times

Carl Hulse and Sheryl Gay Stolberg at NYT:

With Mr. Obama’s health care overhaul stalled on Capitol Hill, Rahm Emanuel, the White House chief of staff, said in an interview that Democrats would try to act first on job creation, reducing the deficit and imposing tighter regulation on banks before returning to the health measure, the president’s top priority from last year.

But Mr. Obama quickly got a taste of how difficult it would be to bring the opposition party on board.

One day after the president upbraided Congress in his State of the Union address for excessive partisanship, Senate Republicans voted en masse against a plan to require that new spending not add to the deficit (it passed anyway as all 60 members of the Democratic caucus hung together). And some Republicans peremptorily dismissed Mr. Obama’s main job-creating proposal, expressing no interest in using $30 billion in bank bailout money for business tax credits.

[…]

Mr. Emanuel, the chief of staff, said he hoped Congressional Democrats would take up the jobs bill next week. Then, in his view, Congress would move to the president’s plan to impose a fee on banks to help offset losses to the Troubled Asset Relief Program, the fund used to bail out banks and automakers.

Lawmakers would next deal with a financial regulatory overhaul, and then pick up where they left off on health care. “All these things start and lead to one place: J-O-B-S,” Mr. Emanuel said.

The execution, of course, will be much easier said than done. Democrats are about to lose their 60-vote supermajority in the Senate, after the recent Republican victory by Scott Brown in a special election to fill the seat held by the late Edward M. Kennedy of Massachusetts. In the Senate, Republicans have come under intense pressure from their colleagues to stay in the fold.

Ezra Klein:

It is very, very, very important to be clear on what the death of health-care reform looks like. It is not a vote that goes against the Democrats. It is not an admission that the White House has moved on from the subject. It is continued statements of commitment from the key players paired with a continued stretching of the timetable. Like everything else in life, policy initiatives grow old and die, even if people still love them.

The timetable Emanuel is laying out makes little sense. The jobs bill will take some time. Financial regulation will take much longer. Let’s be conservative and give all this four months. Is Emanuel really suggesting that he expects Congress to return to health-care reform in the summer before the election? Forgetting whether there’s political will at that point, there’s no personnel: Everyone is home campaigning.

Moreover, there’s a time limit on health-care reform. The open reconciliation instructions the Senate could use to modify the bill expire when the next budget is (there’s disagreement over the precise rule on this) considered or passed. That is to say, the open reconciliation instructions expire soon. Democrats could build new reconciliation instructions into the next budget, but that’s going to be a heavy lift. The longer this takes, the less likely it is to happen. And Emanuel just said that the administration’s preference is to let it take longer. If I were a doctor, I’d downgrade health care’s prognosis considerably atop this evidence.

Jonathan Chait at TNR:

The good news, for those inclined to freak out, is that Emanuel is not necessarily speaking for the administration. (See Jonathan Not Me, who unlike me is highly plugged in.) Emanuel’s message is not David Axelrod’s message. And it’s not Obama’s message. But Emanuel is out there floating his rock tour/Vegas/Army enlistment plan, and that’s a major problem for Democrats, not to mention the national interest.

I see two potential explanations. Either Obama doesn’t know what he wants to do, and his deputies are spreading conflicting stories in order to see what takes, in which case he needs to make up his mind pronto. Or else he wants to do what he says he wants to do, but his chief of staff is out there subverting his agenda and making Congress doubt his seriousness, in which case Obama needs to shut up Emanuel or fire him.

Jonathan Cohn in TNR:

Was this a trial balloon? It’s impossible to know. Emanuel’s qualms about strategic over-reach on health care are among Washington’s worst kept secrets. It’s always possible he was freelancing. But it’s hard to imagine that, in a sit-down interview like this, Emanuel would toss out an idea like this without at least implicit approval from above.

Of course, the official White House line is that they’re not easing up at all. Obama’s public rhetoric backs that up and, privately, several officials say the same thing. The word from Capitol Hill is that leadership is making progress–a lot of progress–on crafting a new compromise between the two chambers.

But getting nervous Democrats in both houses to sign off on that compromise will be tough. A muddled message from the White House, whatever its backstory or intent, only makes that harder.

By the way, the point of trial balloons is to see whether they get shot down. So it might behoove liberals who want health care reform to make clear that lengthy delay is not acceptable. For a few days earlier this week, members of Congress were reportedly getting calls from constituents, urging them to “pass the bill.” More of those calls might be helpful.

Ta-Nehisi Coates:

Earlier in the post Ezra correctly notes that the death of this bill will be a series of delays, not a dramatic vote on the floor. I’d add that it’s really important that progressives not focus their disappointment on the messenger. Rahm Emanuel is an easy foil for us. But Rahm Emanuel works for Barack Obama, not the other way around.

Wesley Smith at First Things:

If the Dems spend the Spring moving on other issues, I don’t see how Obamacare gets forced through before the November election–although, I suppose, they could try after the election.  But refusing to make things even incrementally better in the interim would validate the suspicion in my mind that for the Left, it is all or nothing–takeover or leave the uninsured in their pain because, to paraphrase Rahm Emanuel, “a good crisis is too important to waste.”

John McCormack at The Weekly Standard:

This may be the closest the White House has come to pronouncing Obamacare dead.