Individual State’s Health Innovation and GOP Federalism


Howdy all …

I take it that everyone enjoyed a peaceful if not overly indulgent Thanksgiving week with friends and family.  Turkey was NOT on the Duck’s platter.

Here’s a little news on the Affordable Healthcare Act.

From a blog by David Weigle in, December 1, 2010

Democrats to GOP: Bring on the Federalism!

Speaking to reporters today, incoming Oregon Gov. John Kitzhaber said he was hopeful about the incoming GOP-run House of Representatives in one way. If they “put their money where their mouth is,” and give more flexibility to the states, they’ll make his job easier.

The context: the Affordable Care Act included language, put there by Kitzhaber’s senator, Ron Wyden, which allows states to get waivers and duck the federal mandate to buy health insurance. I followed up and asked specifically if the incoming governors were looking for waivers, and they were. Both Kitzhaber and incoming Vermont Gov. Peter Shumlin said they had met today with Donald Berwick and were looking for waivers that would allow them to pursue their own progressive health insurance reforms. Shumlin said that he ran on a promise to bring single-payer health care to Vermont; that’s what he was seeking.

While the distinguished Senator Ron Wyden, Vermont Gov. Peter Shumlin, and incoming Oregon Gov. John Kitzhaber are leading the charge on bringing about allowing the Innovative States section of ACA to begin sooner, on Election Day California had already received approval for an initial waiver from HHS for the state’s Medicaid system re-alignment receiving $10 billion in federal Medicaid money to extend coverage to some 500,000 people.

In addition to the above, back in September, California had already re-aligned state law for the very thing that Wyden, Shumlin and Kitzhaber are pressing for… And don’t overlook the fact that that guy from Massachusetts in the pick-up truck is a co-sponsor for the Wyden deal. Here’s Wyden’s Official Press Release:

Wyden and Brown Bill Allows States to Create Own Plans Earlier

Can anyone say, Public Option on a state by state level without mandating coverage?

And on another angle, there is also a waiver section in the ACA that can allow for state’s to combine into regional plans, thereby broadening the number of those seeking coverage and in turn bring about more leverage for lower premium policies in the exchanges.

That is all . . .




5 thoughts on “Individual State’s Health Innovation and GOP Federalism

  1. We talked about this before and you know I’m a skeptic. Not because it’s a bad idea in general but because uniform implementation and duplicative costs are hurdles I don’t think can be overcome. Having worked my entire life in an industry that started out without much standardization but which now is highly standardized the benefits are huge beyond measure and we need to be going that way in healthcare. I know this for certain from long experience. Layering of authority for standards development makes for a quagmire of variances that are sure to become unmanageable. Strict, enforceable and auditable process control at every level is the only way to have a system as big as healthcare work efficiently. Our biggest problem is nobody wants to do the work or spend the money to make this happen. Until they do we’ll never have a coherent system that actually works. Government has to take the reins to develop and implement this and only then let vendors supply systems which are certified and are 100% standards compliant.

    1. Geez … That all Sounds so Bureaucratic . . .

      Do you happen to work for NASA? Now there’s bureaucracy for ya’.

      Do you wish to break it down into simple English that a person such as me with a PhD in BS can easily understand?

      Other than that, it’s more confusing than a credit card application and pretty close to blowing more smoke than is necessary.

      But thanks for trying.


      1. I don’t know ducky if you’re jerking my chain or not. What I said is very clear.

        Nothing complex about it and very much based on empirical knowledge and on widely known concepts of large scale information management systems.

        If you don’t know the benefits of this or how any of it works then maybe you shouldn’t be proselytizing about a fragmented alternative plan.

        As I said last we spoke of this I have many years experience in this. The thoudands of vendors all doing their own thing throughout the industry have it in a sorry state of disarray. All are marketing their proprietary solution on the same theme at an obscene cost. This is an industry crying out for standards which are nowhere on the horizon.

  2. Well, I for one am very happy to read this, Duckey! I can’t tell you how much I appreciate your health care updates, as I seldom have time to peruse news stories throughout the day anymore, like I used to.

    I think, also, that several states hooking up for regional plans to lower costs and bring greater access is a fantastic development.

    Thanks for this post!

  3. You know Ducky, I am almost to the point where I would like a structure that would allow state by state ‘opt-ins’ because I have just given up.

    Tomorrow I may feel differently.

    But damn!!! If Texans wish to be pricks, let them be pricks. Just tie these opt-ins to defense contracts and defense installations.

    If you choose not to partake in any federal program, fuck you. You lose.


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