Thursday, February 10, 2011

State Flexibility

Kathleen Sebelius with an op-ed noting flexibility for states in implementing the Affordable Care Act. There seems to be a great deal of variation in what states are doing in the way of using the implementation of the ACA to develop new models. Some states are saying there is not much flexibility, while others, like Vermont are bringing forth grand plans. It seems to me that if a state has goals and a plan to get there that can expand insurance coverage, they should put them forth. Even if the ACA were struck down as unconstitutional, the problems of the default system will remain, and the options of what is feasible in response won't change that much.

There is both the reality of what is allowed in the way of state variation and there is also the political reality, and they aren't the same thing but are likely to converge over time. If a state like North Carolina, which has a Democratic Governor and a Republican General Assembly managed to agree to a plan that sought flexibility in implementing the ACA and seeking some sort of Medicaid waiver, politically it would be hard for the feds to deny a bipartisan state-based effort.

Does anyone have a list or ranking of ongoing or expected activity of what states are likely to do in the way of seek sec. 1332 waivers and/or Medicaid waivers to implement the ACA?

Update: Ezra Klein writing that Sebelius and Daniels need to talk. There is flexibility in the ACA, and I think any state with a concrete plan will get a strong hearing. Saying we can't act because of uncertainty I think is mostly saying we want to bring down the ACA. People are welcome to this position, but if the ACA goes away, the problems won't.

More update: Also via Ezra Klein interesting interview with Vermont Gov on his single payer plan.

And more update: with Aaron Carroll saying the crux of the matter is mandated benefits and there is not going to be agreement.

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