Senators Ron Wyden and Scott Brown have introduced legislation that would move up the date for state to be able to apply for waivers of the Affordable Care Act from 2017 to 2014, so that "states, with a history of innovating new approaches to health care – like Massachusetts, Oregon and Vermont – could continue those efforts, while other states would have an opportunity to start innovating their own approaches." Under their legislation, states would have to demonstrate that they will cover at least as many citizens with coverage that is at least as comprehensive and affordable as the federal law, but if they demonstrate that structure, can waive the individual mandate, the employer penalty for not providing coverage, the exact standards for a basic health insurance policy, and the structure of the health insurance exchange
The Obama administration has signed on.
In remarks to the National Governors Association, Mr. Obama said he backed legislation that would enable states to request federal permission to withdraw from the law’s mandates in 2014 rather than in 2017 as long as they could prove that they could find other ways to cover as many people as the original law would and at the same cost. The earlier date is when many of the act’s central provisions take effect, including requirements that most individuals obtain health insurance and that employers of a certain size offer coverage to workers or pay a penalty.
“I think that’s a reasonable proposal; I support it,” Mr. Obama told the governors, who were gathered in the State Dining Room of the White House.
“It will give you flexibility more quickly while still guaranteeing the American people reform.”
The bill would allow for states to implement single-payer systems, if that's the route they want to go, and at least one state is ready to try. Senator Bernie Sanders told Ezra Klein that Vermont will apply for a waiver.
We believe Vermont stands a chance to be the first state in the nation to pass single-payer. The governor-elect campaigned on it, and we have support in the House and Senate. We’re not asking for one nickel more than we’d otherwise get. The other thing we think we have an opportunity to do is reach out to our conservative friends and say, hey, Vermont wants to go forward with a single-payer system, and Mississippi and Alabama don’t, but maybe they have other ideas. Now, we’re conscious of the need to make sure that the health-care reform bill’s standards aren’t diminished. So everyone needs to provide the same quality of health care as the bill provides and at the same, or lower, price. But if they can do that, then they should be able to go for it.
Regional systems could potentially also be an option, as regional exchanges are an option in the ACA. So it wouldn't be out of the realm of possibility to see a California/Oregon/Washington single payer kind of system eventually emerge. The fight will be with Repubilcan governors, of course, and meeting those requirements for coverage and affordability. We'll soon find out if those GOP governors are truly philosophically opposed to a mandate, and accept this idea, or are just constitutionally opposed to anything created by Democrats, and will continue to fight it.