Sen. Mary Landrieu is a sponsor of the waiver measure
White House officials Wednesday called on Louisiana Gov. Bobby Jindal and congressional Republicans not to dismiss legislation that would enable states to seek waivers from the new health-care law in 2014, three years ahead of schedule.
View full sizeLouisiana Gov. Bobby Jindal, left, talks with Vermont Gov. Peter Shumlin, during a bipartisan meeting of governors hosted by President Barack Obama in the State Dining Room of the White House in Washington on Monday. But the early reaction from Baton Rouge and Capitol Hill was skeptical, with a spokesman for House Speaker John Boehner, R-Ohio, describing the waiver law as a "head fake," and Louisiana Secretary of Health and Hospitals Bruce Greenstein suggesting that implementing wholesale reform "by exception" is unworkable.
"I used to work at HHS (Department of Health and Human Services) and used to run the office that gave those waivers and the number of hoops a state has to jump through, the amount of control that still exists with the federal government, is onerous for states to work through, and you still have to snap to," Greenstein said. "HHS has a way of doing business, and it's difficult to plan the future of your health care system if you're looking at always having to renew."
President Barack Obama told governors at a White House meeting Monday that he backed legislation introduced by Sens. Ron Wyden, D-Ore., Scott Brown, R-Mass., and Mary Landrieu, D-La., that would allow states to seek waivers on how they implement the federal health-care law beginning in 2014, instead of having to wait until 2017 as the law now reads.
Jindal said Monday that while giving states more flexibility is always a good idea, this legislation doesn't go far enough, and what is really needed was to "repeal and replace" the health law.
To get a waiver under the Senate bill a state would have to demonstrate that its plan "covers as many people as affordably and comprehensively as the Affordable Care Act does -- without increasing the deficit," Obama said.
That would be a judgment call by the secretary of Health and Human Services, which Stuart Butler of the conservative Heritage Foundation, writing in The New England Journal of Medicine, said "still locks the states into guaranteeing a generous and costly level of benefits."
"I'm sure you can understand why the law says that before the federal government will give Louisiana billions of dollars for their citizens we have to see that they are going to cover a comparable number of people and do it a comparable cost," said Nancy-Anne DeParle, special assistant to the president who led White House health care overhaul efforts, "and as smart as he (Jindal) is I'm sure he can figure something out -- and you can tell him I said that."
Meeting with a half-dozen reporters Wednesday, DeParle said Jindal shouldn't jump to conclusions about what might be eligible for a waiver.
"I am really surprised that he would prejudge it," DeParle said. "Gov. Jindal used to be the assistant secretary for planning and evaluation in HHS during the Bush administration, which is the office that will be involved in assessing this kind of thing, looking at it from an actuarial standpoint. I wouldn't prejudge that."
Politically, the administration's embrace of the Wyden-Brown-Landrieu bill was seen as an effort to blunt criticism of the new law coming from the states, and DeParle and Stephanie Cutter, deputy senior adviser to the president, were asked whether congressional Republicans wouldn't be inclined to oppose a fix intended to shore up support for a law they are determined to repeal.
"Gosh, I would certainly hope that is not the case," DeParle said.
"All the states are calling for flexibility, and you don't get any more flexibility than being able to build a system now that you can structure around the needs of your state," Cutter said.
But the Republican lawmakers had a different take.
"This is not what the American people voted for Nov. 3 when they voted for repeal and replace," said Rep. Bill Cassidy, R-Baton Rouge.
"Mandating many of the same requirements, this plan would treat states as agents of the very law these governors are running away from," Boehner spokesman Michael Steel said. "A better approach would be working with reform-minded governors to give states more flexibility to lower health care costs immediately by, for example, fixing costly federal regulations on Medicaid."
DeParle said the Senate bill would allow for Medicaid waivers, though she did not know whether that might include allowing a state to craft a block grant system for financing its Medicaid program. The administration is concerned that, in hard times, a block grant might lead states to reduce rolls at the expense of the most vulnerable.
DeParle said that even in advance of the new law kicking in, the administration is working with states to lower Medicaid costs.
"There certainly are ways to achieve the goals of the Affordable Care Act and get everyone in Louisiana covered and lower costs in Louisiana and make some adjustments to the Medicaid program, and you can do some of that today without even waiting for the Affordable Care Act," DeParle said.
Jonathan Tilove can be reached at jtilove@timespicayune.com or 202.383.7827.