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With a Few Tweaks, the Senate Bill Could Allow Single-Payer State Plans

March 9, 2010 - by Donny Shaw

Jon Walker at FireDogLake points out Sec. 1332 of the Senate health care bill, “Waiver for State Innovation,” that would let states exempt themselves from the bulk of its reforms on the delivery side and, theoretically, use federal money from the bill to set up their own single-payer plans.

State plans would have to meet four criteria to be eligible for an exemption from the federal system:

(b) Granting of Waivers-

(1) IN GENERAL- The Secretary may grant a request for a waiver under subsection (a)(1) only if the Secretary determines that the State plan—

(A) will provide coverage that is at least as comprehensive as the coverage defined in section 1302(b) and offered through Exchanges established under this title as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services based on sufficient data from the State and from comparable States about their experience with programs created by this Act and the provisions of this Act that would be waived;

(B) will provide coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title would provide;

(C) will provide coverage to at least a comparable number of its residents as the provisions of this title would provide; and

(D) will not increase the Federal deficit.

But Walker notes a couple ways the provision would needs adjusting in order to actually allow for single payer systems. States would need a way to waive the Employee Retirement Income Security Act (ERISA), which prevents them from dictating what kinds of health plans employers and unions can offer. Also, the Senate health care bill wouldn’t allow for any state waivers until 2017. The Obama Administration will be out be then, and if the White House is run by Republicans, the HHS Secretary would not be likely to grant any waivers for single-payer plans.

If these two things are be changed in the budget reconciliation sidecar, this provision could be a way for House Democrats to win back the votes of their progressive members, like Rep. Dennis Kucinich [D, OH-10], who are planning to vote against the final bill because it locks in and strengthens the private insurance system.

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