Obama Backs Easing State Health Law Mandates

From the New York Times

WASHINGTON — President Obama, who has stood by his landmark health care law through court attacks and legislative efforts to repeal it, told the nation’s governors on Monday that he was willing to amend the measure to give states the ability to opt out of its most controversial requirements right from the start, including the mandate that most people buy insurance.

In remarks to the National Governors Association, Mr. Obama said he supported legislation that would allow states to obtain waivers from the mandate as soon as it took effect in 2014, as long as they could find another way to expand coverage without driving up health care costs. Under the current law, states must wait until 2017 to obtain waivers.

The announcement is the first time Mr. Obama has called for altering a central component of his signature health care law, although he has backed removing a specific tax provision that both parties regard as onerous on business.

But the prospects for the proposal appear dim. Congress would have to approve the change through legislation, and House Republican leaders said Monday that they were committed to repealing the law, not amending it. Even if the change were approved, it could be difficult for states to meet the federal requirements for the waivers.

The White House described the proposal, based on a bipartisan bill recently introduced in the Senate, as a common-sense date change that would give states the freedom to innovate and act as laboratories. Mr. Obama called it “a reasonable proposal,” telling the governors, “It will give you flexibility more quickly while still guaranteeing the American people reform.”

Political calculations, as much as policy ones, were at work in the president’s announcement. The shift comes as the health care law — and the mandate in particular — is under fierce attack in the courts, where federal judges have issued conflicting opinions on its constitutionality. The mandate is also a rallying cry for conservatives and Tea Party supporters, who regard it as a prime example of overreaching by the federal government.

Mr. Obama has been trying to reposition himself in the political center on some issues in the wake of the drubbing his party took in the November midterm elections; dropping his insistence on the mandate is one way to do that. And with governors pressing the administration to allow them to cut Medicaid rolls to ease their fiscal distress — a step Mr. Obama does not want to take — the president is trying to look flexible in other ways.

But Mr. Obama’s flexibility goes only so far. “I am not open to refighting the battles of the last two years,” he said, “or undoing the progress that we’ve made.”

Mr. Obama’s announcement did not appear to appease his Republican critics. The House majority leader, Representative Eric Cantor of Virginia, told reporters that the health law was “an impediment to job growth” and that Republicans remained committed to its repeal.

And while some Republican governors praised Mr. Obama for reaching out, they said the move did not address their underlying discomfort with the law or the major structural flaws facing state budgets. In meeting with the governors, Mr. Obama also asked them to come up with a bipartisan group to find ways to reduce Medicaid costs.

“I was disappointed,” said Gov. Rick Perry of Texas, chairman of the Republican Governors Association. “Pretty much all he did was to reset the clock on what many of us consider a ticking time bomb that is absolutely going to crush our state budgets. The states need more than that.”

Some Democrats also reacted warily. Many are convinced that it is not possible to expand health care coverage and achieve deficit reductions without the federal mandate, and they worry that amending the law would be tantamount to weakening it.

Senator Max Baucus, a Montana Democrat who as chairman of the Senate Finance Committee wrote a bill that included an idea similar to the one Mr. Obama proposed, issued a tepid statement saying he would consider it.

“We want to give states as much flexibility as possible,” Mr. Baucus said, “but that flexibility shouldn’t fail to ensure that Americans in every state have access to quality, affordable health care.”

The White House said the proposal was unrelated to the challenges to the constitutionality of the mandate. But encouraging states to pursue alternative ways of expanding coverage could prove useful should the Supreme Court ultimately rule that the mandate is unconstitutional.

At the same time, the mandate, and the health care law more generally, is sure to be an issue in the president’s 2012 re-election campaign, which may be a reason he is offering the proposal now.

“It’s to his advantage to show that he wants to be more moderate on this,” said Dan Mendelson, a health policy expert who worked in the Clinton administration, “because the mandate is terribly unpopular politically and he doesn’t want to be saddled with that going into the next election.”

The bipartisan legislation that Mr. Obama is now embracing was first proposed in November, eight months after the enactment of the Affordable Care Act, by Senators Ron Wyden, Democrat of Oregon, and Scott Brown, Republican of Massachusetts. Senator Mary L. Landrieu of Louisiana, a Democrat, is now a co-sponsor.

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