According to the Huffington Post
Obama pointed Kucinich toward single-payer language that Sen. Bernie Sanders (I-Vt.) was able to get into the bill. Kucinich fought for an amendment that would allow states to adopt single-payer systems without getting sued by insurance companies. Obama told Kucinich that Sanders's measure was similar but doesn't kick in for several years. "He definitely wrote it down," said one member of Kucinich, suggesting that he'd look into it.
So what did Obama point Kucinich to?
In all likelihood it was Section 1332, Waiver for State Innovation of the Patient Protection and Affordable Care Act. (To find Section 1332 click on 'Full Text of the Bill as Passed (pdf), and then search for 1332 twice. Thanks to Kossack Cedwyn for pointing me at the section in this diary in this comment subthread).
And what does that section actually say? It's pretty long, has some complicated wording, and some subsections refer to other sections of the document and the IRS code. But here are what I take to be the most relevant clauses.
This first one seems to validate the President's assertion that the language doesn't kick in for several years:
(1) IN GENERAL. A State may apply to the Secretary for the waiver of all or any requirements described in paragraph (2) with respect to health insurance coverage within that State for plan years beginning on or after January 1, 2017.
And these, which lay out the basic restrictions on any waiver:
(1) IN GENERAL. The Secretary may grant a request for a waiver under subsection (a)(1) only if the Secretary determines that the State plan
- (A) will provide coverage that is at least as comprehensive as the coverage defined in section 1302(b) and offered through Exchanges established under this title as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services based on sufficient data from the State and from comparable States about their experience with programs created by this Act and the provisions of this Act that would be waived;
- (B) will provide coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title would provide;
- (C) will provide coverage to at least a comparable number of its residents as the provisions of this title would provide; and
- (D) will not increase the Federal deficit.
There is an additional provision, Section (3), which, as far as I can make out, specifies that federal funds which would otherwise not be flowing into a state because that state had implemented an alternative system would be estimated by the Secretary and given to that state anyway. So if California were to implement a single-payer system and businesses and individuals did not have to pay premiums any more, then any monies that would have been sent to Californians via the tax subsidies for purchasing insurance would get sent to California to help pay for the cost of medical care in the State. That's my take on it anyway.
So the bottom is line is good and bad. Yes, it seems that with the usual bureaucratic caveats and the understanding that I might be missing something important in the wording, it would be possible for a state to set up a single-payer system. But no such system would be able to be put in place until 2017, almost seven years hence. That seems ridiculous.
If California elects a Democratic governor, it may be able to enact a single payer law as early as sometime in 2011 (it's not clear to me when SB 810 would go info effect). A few other states (e.g., Pennsylvania) may consider single payer legislation in the near future.
There is no obvious reason why, aside from Republican and possibly Blue Dog pig-headedness, a bill amending this provision to change 2017 to an earlier time could not be passed, even if not through reconciliation. After all, what could be more "States' Rights" and Tenth Amendment that letting states determine their own health care systems?
I have no idea what Kucinich wants, if anything, for his vote, but if indeed he wants states to have the ability to institute single payer it seems like he already has it, and if he wants it sooner than 2017, this seems like a simple enough fix.