With Health Care, the Time Is Still Now: Democrats Should Seize Opportunity, Push For Better, Sooner State Waiver

The newly passed health care law is not popular, and Republicans are starting to line up behind a political strategy of calling for its repeal. While true repeal seems like a legislative impossibility, the political strategy might work. When forced to choose between the false duality of this new health care law or no law, a large portion of the American people line up behind repeal. The relatively good news for Democrats is that most Americans don't like the bill, but would prefer to see it significantly changed instead of repealed. This creates the perfect political environment to push for a better and quicker optional state waiver.

The “Patient Protection and Affordable Care Act” is an unpopular bill that even most of its “supporters” are unhappy with and want to see changed. It seems the only people who are happy with the final product are Joe Lieberman, Max Baucus, and a army of industry lobbyists. According to a Fox News Poll, the only poll I have seen phrasing the question as such, just 12% of Americans want to see the new law implemented as is, but only 36% wanted it completely repealed. When also given the choice of the new law, but with significant changes, that is the choice most Americans flock to. This shows the false dynamic produced by asking a “this new law or repeal” question on an unpopular bill meant to deal with a people that people think is important to solve.

33. What do you want to happen with the new health care law -- make sure it is implemented as it is, make changes to it, or repeal it all together?
SCALE: 1. Implement it as it is 2. Make changes to it 3. Repeal it all together 4. (Don’t know) Implement Make changes Repeal (Don’t know)

	Implement	Make changes	Repeal	(Don’t know)
6-7 Apr 10	12.00%	47	36	4
Democrats	27.00%	56	12	5
Republicans	2.00%	34	62	3
Independents	6.00%	54	35	5

With Republicans calling for repeal, but most American wanting the bill seriously modified, this is a potentially advantageous political moment for Congressional Democrats who believe state-based action is the only hope for achieving real reform (state single payer) to push for a better state waiver that starts sooner. Currently, the law has a provision letting states get a waiver from the law to use the money to try a different health care system. It has two major problems. It does not start until 2017, three years after the state is forced to adopt the exchange model, and it does not cover all health care laws, most importantly, ERISA.

A smart political and policy move would be for Democrats to put forward a bill/amendment to improve and move up the state waiver. Possibly even setting aside some money for states that might want to experiment with new models before 2014. It would allow for things like a state single payer system, a Hawaii-style strong employer mandate system, German-style non-profit insurance all-payer system, possibly a Singapore style catastrophic coverage plus HSA program, etc. It could be sold as allowing people to get the changes they want at a state level. It would be a way to blunt criticism of a “federal takeover of health care" and complaints about specific components, like the individual mandate.

Importantly, it would force Republicans into a box canyon if they voted against it. It would show that Republicans in Congress don't care about states rights or trying to replace the new law with better Republican solutions. They only want to return to the status quo. It would allow Democrats to paint Congressional Republicans as squarely in a minority that not only opposes the design of this new law, but opposes any possible action to deal with our health care crisis.

I know Congressional Democrats don't want to deal with health care anymore, and frankly plan to avoid doing almost anything until November. But they are missing a great opportunity to possibly advance progressive policy, rally the base, improve the politics of health care for Democrats, and/or make Republicans look like cynical radicals. Advancing a bill that would immediately allow states to completely free themselves from the new health care law as long as they come up with an equal or better system would force Republicans into a very tough vote. It would allow Democrats to claim they are listening to the American people who want the bill changed, and to their base who wanted more progressive reform, and paint the Republicans as only having the goal of opposing any attempt to address health care.