President Obama said yesterday he will give states new leeway in implementing the national health care law — if they can provide affordable benefits and help residents obtain coverage without increasing the federal deficit. We explore the ramifications for the states and for the broader health care debate.

Guests

  • N.C. Aizenman Reporter, The Washington Post

Transcript

  • 13:06:39

    MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, the tax man cometh, what you need to know before filing your tax return this year. But first, the White House tries to cut an early spring deal on healthcare. President Obama endorsed a plan yesterday to give states a chance to opt-out early of certain pieces of the new healthcare law. But, there's a catch. He wants states to prove they can provide affordable, comprehensive benefits to their residents without adding to the federal deficit before they move on with their own plans.

  • 13:07:27

    MR. KOJO NNAMDIIt's a deal that puts the ball back into the hands of the states, many of which have already sued to overturn the new federal law. Joining us to explore how this proposal is likely to shape the broader debate about healthcare is N.C. Aizenman. N.C. is a reporter for The Washington Post. N.C., thank you so much for joining us.

  • 13:07:47

    MS. N.C. AIZENMANThanks for having me on.

  • 13:07:49

    NNAMDIThe states began the legal war against the new healthcare law as soon as the ink on it was dried. The president yesterday threw his weight behind a compromise of sorts that allows them to opt-out of certain parts of it if they can prove they're able to accomplish the goals of the law on their own. What exactly are the terms of the deal the president endorsed?

  • 13:08:11

    AIZENMANWell, this is a proposal -- this is a bill that is -- was introduced by three senators so that, of course, means that Congress would actually have to pass this bill. It's not up to the president to simply approve it. And it would essentially speed up a provision that's already in the law. The law already says that certain keys areas of the statute could be waived for states starting in 2017 and this would move that timeline up to 2014.

  • 13:08:43

    AIZENMANIn particular, it would apply towards the law's mandate that states can create these exchanges. These are marketplaces through which individuals and very small businesses could purchase private insurance. Similarly, the law has a mandate that virtually all Americans have to obtain insurance. And then there's also a mandate that mandates on the extent to which employers need to offer insurance.

  • 13:09:08

    AIZENMANThose provisions of the law states could opt out of. However, they would need to prove that in doing so they're still providing coverage that is as least as comprehensive as what's offered under the law, that is at least as affordable, that covers as many residents as it would have otherwise and that it doesn't increase the federal deficit. So those four criteria actually narrow the scope of innovation potentially for states.

  • 13:09:39

    NNAMDIYou mentioned that it requires the approval of Congress. What is the likelihood that it would be approved by the Congress?

  • 13:09:46

    AIZENMANI mean, that's definitely a long road ahead. You know Senator Reid, the majority leader of Senate...

  • 13:09:57

    NNAMDIHarry Reid, yes.

  • 13:09:58

    AIZENMANHis response yesterday was, you know, open to it, but he certainly didn't sound like someone who was, you know, going to be making this a priority. Republicans greeted it with a fair amount of skepticism.

  • 13:10:11

    NNAMDIHow about Republican governors in particular because they are openly against the healthcare law? How are they responding to it?

  • 13:10:17

    AIZENMANThey, a sort of mixed response, some of them, you know, expressed a sort of general, you know, sort of favorability to the idea of any kind of flexibility but they were also making note of the fact that, you know, these four criteria essentially would make it difficult for them to get around provisions that they disagree with in law.

  • 13:10:41

    AIZENMANTo give you an example, the law is going to require that on these plans that are sold on these marketplaces, these exchanges, have to carry a minimum essential benefits package. There are certain essential benefits that the plans must carry. Those benefits are going to be spelled out by the administration. It's a long process that they're involved in right now. They're saying they're getting input from lots of stakeholders but eventually there will be that package of benefits and any plan has to offer it on the exchanges. States could make it, could up the requirements, but there's that minimum.

  • 13:11:13

    AIZENMANNow, there's some concern that if that package is made too generous, the plans will be too expensive and the law won't work very well and so that's one of the complaints that some governors have. In these criteria, if you want to get around the exchanges and maybe do some other way of, you know, offering health insurance you still need to quote, provide coverage that is at least as comprehensive. So basically that minimum, essential benefits package would still hold.

  • 13:11:43

    NNAMDIYou wrote a week ago, N.C., about how governors and Republican states are trying to undermine and overturn the law even while they're working on another track to implement it. Can you explain that? And what's the strategy behind this apparent nuance?

  • 13:11:56

    AIZENMANYeah, there's basically, they have kind of two competing incentives. On the one hand, you know, there's a recognition that in 2012 there will be elections and that could really influence the ultimate outcome of this law, you know, if there's a changeover in the White House and further consolidation of Republican power in Congress they could substantially amend or even repeal the law. So they're sort of, politically they're trying to make that case and lay the groundwork for that.

  • 13:12:25

    AIZENMANAt the same time, if they don't succeed and if the law is upheld in the courts by the Supreme Court, ultimately, then the way the law is structured if states don't comply -- for example, if states don't create these exchanges on their own, well then the law empowers the federal government to come in and set up its version, which could be different than what the states would consider optimal. And so there's an incentive for states to sort of hedge their bets and prepare simultaneously to comply if they don't succeed in overturning or vastly changing the law.

  • 13:13:02

    NNAMDIOne of the first shots fired against the new law came in Virginia where Attorney General Kenneth Cuccinelli went to court immediately after the bill was signed to challenge the individual mandate portion of it. Yet you wrote that Virginia Governor Bob McDonnell is perhaps the best example of a governor who is both attacking and implementing the federal healthcare plan. What is his strategy all about?

  • 13:13:24

    AIZENMANYou know, he's very upfront about the fact that he, you know, that he doesn't see it as an inconsistency. I mean, from his point of view, he's made clear, you know, he has concerns about the law. He'd like to see it overturned by the courts, but on the other hand, until that does happen, it is as his staff put it, the law of the land. So, you know, it makes sense to try to comply with it in a way that, you know, gives Virginia as much power as possible over the shape of the implementation rather than handing that over to the federal government. So his, you know, he's kind of pursuing that dual track strategy, you know, and being quite upfront about his logic for doing so.

  • 13:14:04

    AIZENMANThere's a different model that some other states have followed, Alaska is perhaps one of the best examples. Florida is another where it's a different approach, it's more of a go-slow approach. They're just not, they're not moving as fast. It's hard to know whether that really amounts to obstruction because there's still a lot of time, you know, we're talking about implementation in 2014 so we'll see how long that go-slow approach lasts.

  • 13:14:28

    NNAMDIAnd finally this, N.C., how would you describe the politics at work here? Is the president's move one that puts pressure on governors to come up with better ideas?

  • 13:14:39

    AIZENMANI think it does. I think it was a way to diffuse criticism essentially saying okay you want flexibility I support giving you more flexibility and then, you know, it's up to you to meet the overall objectives of this law. If you have a different way you want to do it I'm open to that. The governors' response in some cases is well we don't agree with your imposing of the objectives of the law to begin with, you know. We have other objectives.

  • 13:15:07

    NNAMDIThank you very much for joining us.

  • 13:15:08

    AIZENMANThanks for having me on. It's been a pleasure.

  • 13:15:09

    NNAMDIN.C. Aizenman is a reporter at The Washington Post. We'll take a short break. When we come back tax filing tips for you. You can start calling in now, 800-433-8850 or go on to our website, kojoshow.org. I'm Kojo Nnamdi.

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