Freedom Line Blog

Over at The Corner, the incomparable Yuval Levin has a great explainer on why President Obama’s accomodationist tone on health care in yesterday’s White House speech to the National Governors Association was a headfake. He notes:

Speaking to a group of governors yesterday, the president said he would support legislation that would allow states to opt out of some of Obamacare’s requirements (including the individual mandate, the employer mandate, and the state exchanges) if they show they can achieve exactly the same results in some other way. Obamacare itself actually already contains such a provision, but it would allow states to apply for such waivers starting in 2017—after these mandates and requirements have been in place for three years. Obama now says he would let states apply for waivers in 2014, when the new rules begin.

This change of heart, like the one regarding the CLASS Act, is a concession to the fact that the law’s requirements are understood by many state officials (of both parties) as immensely burdensome and problematic. But like the one regarding the CLASS Act, it is also not an actual concession in practice. The states would be required to show that their alternative policies would provide the same or greater insurance benefits to the same or greater number of people, presumably as assessed by HHS. So it allows no flexibility regarding ends, and therefore very little flexibility regarding means. In fact, while it would allow conservative-leaning governors essentially no freedom to move in the direction of greater competition and more consumer-driven health care (which conservatives tend to see as the actual path to reducing costs and therefore insuring more people while improving quality) it would give liberal-leaning governors significant freedom to move in the direction of more government control. Indeed, as the New York Times notes today, while the approach Obama supports would not allow for many consumer-driven reforms it “might allow interested states to establish a single-payer system in which the government is the sole insurer.”