A handful of states are pursuing ambitious health care changes that go far beyond the Obama administration’s 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.
Democratic governors who want to push reforms further are asking to be waived from key parts of the federal law.
“The Affordable Care Act’s main goal was to expand coverage,” said Oregon Gov. John Kitzhaber, a health care reform stalwart. “We’re trying to pivot from that and go quite a bit further.”
Oregon passed its own plan this year, which changes how it pays doctors and eventually ends with allowing public employees to enroll in Medicaid.
In May, Vermont became the first to attempt to implement a single-payer system.
The federal law allows states to pursue ideas outside of its purview with State Innovation Waivers, so long as they can meet certain benchmarks on cost and coverage.
But the waivers start in 2017, three years after most of the law takes effect. That timeline is problematic for states such as Oregon and Vermont.
President Barack Obama backs legislation that would allow the waivers to start in 2014. But it has been languishing in the Senate for months.
“Since we’re proposing to save citizens’ money, you’d expect some kind of chorus and music, maybe a presentation with some plaques and flowers,” said Montana Gov. Brian Schweitzer, a Democrat who wants to open his Medicaid program to government employees and individuals. “But in my experience, that’s not what you get.”
The Obama administration has spent “countless hours” working with states to implement ideas that diverge from the federal law, said White House spokesman Nick Papas.
