Re: The Next Stage of the Health-Care Debate

by Tevi Troy

Yuval’s post on new developments in the health-care fight explains why President Obama felt the need to claim to offer states more flexibility in the implementation of his health-care law. I agree with Yuval’s description of how the offer falls short from a policy perspective, but it has two additional flaws as well.

First, the Obama offer creates a political trap for Republicans. Governors who pursue the waivers will be trotted out as demonstrations of how flexible and bipartisan the law is, which is not a comfortable place for GOP politicians right now.

Second, Obama’s rhetoric betrays the limits of his flexibility. This is not the first time he has come forward with an open hand that in reality was not so open. In September of 2009, he said: “If you come to me with a serious set of proposals, I will be there to listen.” In February of 2009, he said: “I won’t hesitate to embrace a good idea from my friends in the minority party.” As we know, Obama went forward with his approach, and Obamacare passed with no Republican votes and 34 Democratic votes against it in the House.

This time, the president’s words were: “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.”

The problem with this offer, and Obama’s previous offers of flexibility, is the vagueness of the key words. He gets to decide what is “serious,” what is a “good idea.” In this case, he — specifically, skeptical senior officials at HHS — gets to decide in advance whether market-based reforms would “create a plan that covers as many people as affordably and comprehensively.”

As the Scottish philosopher Montgomery Scott wisely said: “Fool me once, shame on you. Fool me twice, shame on me.” Republican governors should proceed with caution.

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