Dave Weigel reports on the proposal from Sens. Lindsey Graham (R-SC) and John Barasso (R-WY) to allow states to opt out of the Affordable Care Act.
Senators John Barasso, R-WY, and Lindsey Graham, R-SC, have introduced The State Health Care Choice Act, written to allow states to opt out of the individual mandate, the employer mandate, expansion of Medicaid programs and "new federal requirements for regulating health insurance." The senators, introducing the legislation at a presser, were admirably blunt....
"We're opening up a third front in the challenges against Obama health care," said Graham. If the bill passed, "it would be easier for me to imagine more than half the states opting out of Obamacare. The bill would fall." Graham got a follow-up question, asking whether opting out would shrink the risk pool. "You've hit the point. The goal is repeal and replace." The goal was to bring the debate over health care into the 2012 campaign and into "the streets."
Except that it really doesn't have anything to do with the "replace" part of the "repeal and replace." There's no policy here, nothing that replaces the insurance reforms in the ACA needed to expand coverage. It's just repeal, allowing states to opt out on implementing any of the reforms, and continue with the status quo.
The existing law includes an option for states to get waivers to develop their own approach that comply with the goals of the ACA. Sens. Ron Wyden (D-OR) and Scott Brown (R-MA) have an initiative that would allow states to get those waivers three years earlier than in the ACA, in 2014 rather than 2017, but the requirement that states actually do something to expand coverage is still there. Not with the Graham-Barasso plan.
What sets Graham and Barrasso apart is that under their approach, states wouldn't have to institute their own sets of reforms before leaving the federal system. With the current law or the Wyden-Brown alternative, the Health and Human Services secretary could grant a waiver....
[W]hile Graham might argue that the pure opt-out clause is the equivalent of repealing and replacing Obama's bill, the likely end result of his legislation would that a good chunk of the country simply fails to push any additional reform.
"It looks like what they are introducing is a straight-up opt-out which would allow states to gut the law without implementing anything in its place," a top Democratic Senate aide said.
They might try to sell this as a replacement policy, but it's not. It's simply a ploy to do exactly what they said: "The goal was to bring the debate over health care into the 2012 campaign and into 'the streets.'" It has nothing to do with fixing America's healthcare crisis.