fresh voices from the front lines of change







After the President signed the health reform law, opponent GOP Sen. Scott Brown immediately promised to push for changes. In a March 30th Boston Globe oped, he wrote: "I am working on legislation that would allow states to opt out of this federal health care bill because states need flexibility, not a federal government takeover of health care. Instead, individual states should have the flexibility to solve the health care problems in a way that is best for their specific state..."

What Sen. Brown did not acknowledge at the time was that the law already provided states with that flexibility. This week, he effectively did.

As I noted back in September, "...there is a provision in the law that allows states to reject the federal approach to reform altogether, so long as they set up something else that expands coverage at least as much and controls costs at least as much. That could include either a single-payer system or private market-based approaches."

That provision was created by Dem Sen. Ron Wyden, which was barely noticed until he announced he wanted his own state of Oregon to take advantage of it and avoid having an individual mandate to purchase insurance.

Conservatives charged Sen. Wyden with hypocrisy, but there is nothing hypocritical about creating a law that allow states flexibility to expand health insurance coverage, and then helping your state exercise that flexibility.

Now, Sens. Wyden and Brown have created bipartisan legislation to tweak the date when states can apply for waivers, from 2017 to 2014. As the individual mandate goes into effect in 2014, the Wyden-Brown bill would mean states wouldn't have to try out the mandate for a few years before applying for a waiver.

On one hand, the bill means Sen. Brown is following through on his pledge to modify the health reform law.

On the other hand, Sen. Brown's legislation is tacit acknowledgment from him that the law already provides states with flexibility.

After all, it doesn't introduce a brand new state waiver from the individual mandate. It simply changes the date to accept applications a waiver that was already created.

No doubt the individual mandate remains a hotly contested part of the law (undercutting the bizarre notion that the law was politically timid) and opinions can cut across ideological lines.

In the 2008 presidential primaries, some liberals equated the mandate with support for universal coverage, but in 2010 some chafed that it meant mandating the purchase of private insurance. Many conservatives equate it with federal government takeover, but some conservatives, like Sen. Brown and former Gov. Mitt Romney have defended the mandate as adhering to the principle of personal responsibility.

The truth is, you don't have to support the individual mandate to support the health reform law. You just need to work with officials in your state to come up with an alternate path to expand coverage and control costs.

Not exactly a federal government takeover. Ask Sen. Brown.

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