As far as health-reform boosters go, Oregon Gov. John Kitzhaber is among the most stalwart.
“We want to show that health reform is something real, that it actually works,” he said. “Oregon is a place that can actually make it happen.”
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His state has aggressively implemented the health overhaul Congress passed last year, taking more than $100 million in federal funding to do so.
But at the same time, the health-care law puts Kitzhaber (D) in a bind. This year, Oregon passed its own plan, which starts with changing how it pays doctors and eventually ends with allowing public employees to enroll in Medicaid, the federal insurance program for low-income Americans. There’s just one big obstacle: What Oregon wants to do would require the Obama administration to waive integral pillars of its signature legislative accomplishment.
“We would need a number of waivers to implement all of this,” he said. If Oregon doesn’t get them? “That,” Kitzhaber said, “would be a problem.”
Kitzhaber isn’t alone. A handful of states are pursuing health measures that go far beyond the Obama administration’s signature legislative accomplishment, the Affordable Care Act.
They stand in contrast to Republican governors, who have aggressively opposed the law. Twenty-seven states are challenging the law in the courts as unconstitutional, while two, Florida and Louisiana, have just refused to implement much of the law.
For Democratic governors who want to push changes further, navigating the federal law is a much more complex and nuanced task. They want to implement the law, as well as be waived from key parts of it.
“The Affordable Care Act’s main goal was to expand coverage,” Kitzhaber said. “We’re trying to pivot from that and go quite a bit further.”
The health-care law does allow states to pursue ideas outside its purview. It includes State Innovation Waivers for those that want to bypass key components such as the mandated purchase of insurance, so long as they can meet certain benchmarks on cost and coverage. The waivers become available in 2017, three years after most of the law takes effect.
But for states such as Oregon and Vermont, that timeline is problematic. Because most of the law takes effect in 2014, they worry about setting up a system only to dismantle it a few years later, to implement the policies they really want.
In February, President Obama endorsed legislation that would allow the waivers to start in 2014. But it has been languishing in the Senate for months, never seeing a committee hearing.
Meanwhile, states continue to lay the groundwork for health measures that go well beyond the Affordable Care Act, meeting regularly with administration officials to discuss what flexibility might be available.
Vermont has moved swiftly in pursuing universal health care. In May, the state became the first to attempt to implement a single-payer system. The state has begun discussions with the Obama administration about waivers that would be necessary to convert health insurance there into a single-payer health plan, run by a public board.
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