An interesting AP story earlier this week explained a report produced by Harvard economist William Hsiao for the Vermont state legislature about ways the state could save money by shifting to a single-payer health care system.
My colleague Igor Volsky runs down some of the hurdles and possibilities offered by federal law:
Hsiao said that Vermont faced “no fewer than 15 hurdles before it would be able to implement the plan,” not the least of which are some of the new requirements and regulations in the Affordable Care Act. The Vermont Congressional delegation has introduced an amendment that would expand a provision in the law that allows states to propose their own pilot health care programs and seek a waiver from the federal health care law so that they can pursue their own approaches to health care reform. The current law allows states to pursue these waivers in 2017; the amendment would move this waiver date up to 2014. A companion measure has also been introduced by Sens. Ron Wyden (D-OR) and Scott Brown (R-MA) in the Senate, but it remains to be seen how cooperative HHS will be in granting waiver and allowing the state to pursue these reforms.
In political terms, it seems to me that being generous about the state customization possibilities is probably the best way to start shifting the Affordable Care Act out of the toxic partisanship box and regularize its place in the firmament. Among other things, this provides something of an exit pathway for politicians like Scott Brown who don’t want to embrace ACA but also don’t want to repeal it.