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Obama Backs Wyden-Brown Flexibility Proposal

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President Obama is throwing his weight behind a bipartisan Senate effort to give states more room to come up with their own approach to implementing the Affordable Care Act.

Obama announced his support for S. 3958, the Empowering States to Innovate Act bill, today at a White House meeting with members of the National Governors Association (NGA), Washington.

The bill, introduced by Sen. Scott Brown, R-Mass., along with Sens. Ron Wyden, D-Ore., and Mary Landrieu, D-La., would, give states the authority to get waivers from the regular Affordable Care Act package rules in 2014, rather than requiring them to wait until 2017.

“I think that’s a reasonable proposal,” Obama told the governors. “It will give you flexibility more quickly, while still guaranteeing the American people reform. If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act does — without increasing the deficit — you can implement that plan. And we’ll work with you to do it.”

Senate Swing Voters

Just 18 months ago, the Democrats had solid majorities in the House and the Senate, and Obama had little need to reach out to Republicans.

The Senate gave Republicans some chance to weigh in on development of the Patient Protection and Affordable Care Act (PPACA) — the core of the Affordable Care Act — but the House mostly shut them out, and Republicans complained bitterly that the Democrats had left even Republican amendments with Democratic support out of the final version of the act.

Brown became one of the few Republicans in Congress to cross party lines on a high-profile vote when he voted for H.R. 4173, the bill that became the Dodd-Frank Wall Street Reform and Consumer Protect Act.

Since then, the Republicans have gained a strong majority in the House, come close to parity in the Senate, and increased the number of Republican governors to 29. Many Republican governors have gone to court to block implementation of the act, and some are canceling existing PPACA implementation efforts. Scott Brown

Obama today tried to mend fences with Republicans — and skeptical Democrats — at the NGA meeting by emphasizing their common interest in getting health care costs under control.

Obama noted that one of the biggest burdens facing the states is Medicaid costs, and that the biggest driver of the federal debt is Medicare costs. “Nothing else comes close,” Obama said. “We could implement every cut that the House of Representatives right now has proposed and it would not make a dent in our long-term budget, wouldn’t make a dent in our long-term deficits — because of health care costs.”


Obama repeated earlier calls for bipartisanship and flexibility.

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“I don’t believe that any single party has a monopoly on good ideas,” Obama said. “And I will go to bat for whatever works, no matter who or where it comes from.”

States should have the ability to come up with their ideas for reforming the health care system, such as setting benefits standards that fit local conditions and encouraging use of health savings accounts, Obama said.

Obama mentioned two existing health insurance exchange distribution

systems operated by Utah and Massachusetts.

A PPACA health insurance exchange provision is supposed to take effect in 2014.

Massachusetts and Utah operate very different health insurance distribution exchange programs, and they can and should be able to continue to operate the exchanges in their own way, Obama said.

In a fact sheet, White House officials have described existing Affordable Care Act provisions that they believe allow for flexibility.

A PPACA “state innovation waiver” provision lets states propose and test alternative methods for expanding access to coverage, officials say.

A state can qualify for a waiver if its alternative program will:

  • Provide coverage that is at least as comprehensive as the coverage offered through exchanges.
  • Make coverage at least as affordable as it would have been through the exchanges.
  • Provide coverage to at least as many residents as the Affordable Care Act would have provided.
  • Do nothing to increase the federal deficit.

But officials say any states with waivers must maintain “important consumer protections” against the “worst insurance company abuses.”

Officials say insurers in states with waivers:

  • Cannot impose lifetime limits on the dollar amount they will spend on health benefits.
  • Must offer young adults without access to job-based coverage the option of remaining on their parent’s plan until their 26th birthday.
  • Must cover recommended preventive services without cost sharing.
  • Must allow patients to choose their own doctor in their network.
  • Cannot drop consumers’ coverage solely due to the consumers getting sick.
  • Must spend at least 80% of premium dollars on health care.

Starting in 2014, insurers in states with waivers cannot charge more, carve out benefits, or deny coverage because of a pre-existing condition, officials say.