Monday, May 18, 2015

Post-King fallout: Waiting for Superwaiver?

I have a post up at that recounts opposing forecasts from two moderate conservatives about likely Republican behavior if the Supreme Court rules for the plaintiffs in King v. Burwell.  invalidating subsidies credited through

First up is Stuart Butler, generally considered the father of the individual mandate, long at Heritage, now at Brookings. The other is Christopher Condeluci, a former Republican Senate Finance Committee staffer who was involved in that committee's efforts to report out a bill with bipartisan backing (he has said that there was agreement between Republicans and Democrats on the committee on about 80% of the substance of what became the ACA).

The two were on a panel on likely post-King fallout at the Health Insurance Exchange Summit in D.C. last week. Here's the upshot of their disagreement:
Stuart Butler.. suggested that Democrats who wanted to preserve the ACA's core framework and Republicans looking to alter it might find "Houdini-like" escape from their impasse by taking inspiration from the ACA's "innovation waivers." These waivers empower states to propose alternative schemes that meet the ACA's coverage and affordability goals by different means...Butler spoke hopefully of a "superwaiver process" that would speed up the timeline and ease the application process,  giving states more freedom to shape their health insurance markets with less oversight from the federal government.

Christopher Condeluci... acknowledged that some Republican proposals to amend or replace the ACA are "1332-like" -- that is, they codify the kind of changes that states could propose under the ACA's innovation waivers. But he insisted that "Republicans aren't looking to 1332" as a framework for implementing those reforms. They would seek to offer states a Republican alternative that would serve as a sort of prepackaged (and pre-approved) 1332 waiver that would include repeal of the individual and employer mandates and of HHS guidelines for Essential Health Benefits that must be covered by all health plans.
I thought it pretty plain that Condeluci is in tune with what Republicans in Congress want, or profess to want -- "A GOP alternative [that] would not involve HHS's blessing in any way, shape or form." But it's at least possible that Butler could hit near to what they'll settle for -- if public opinion comes down heavy on them as a subsidy cutoff looms. Please see the post for my read (and speculation).

Not all of my conversation with Condeluci made it into the piece. I will follow up soon, here or elsewhere. He opens an interesting window on current GOP thinking about healthcare reform.

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