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No, he can’t

This week, President Obama gave Republican critics of the Affordable Care Act a way out, if they met certain conditions.

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.”

As Kevin Drum observed, this was basically a poker play.

Obama is calling the bluff of Republicans who insist that they can build a healthcare system that’s as extensive and affordable as PPACA using some combination of tea party-approved “free market” principles. He’s telling them to put their money (or, rather, money from the feds) where their mouths are, which will probably demonstrate fairly conclusively that they can’t do it. It’s possible that a state like Oregon might enact a more liberal plan that meets PPACA standards, but I doubt that Alabama or Tennessee can do it just with HSAs and high-deductible health plans.

Still, we’ll see. This is a chance for conservatives to show that they have a better healthcare answer in the real world, not just as talking points at a tea party rally. Obama is betting they’ll fail, and he’s also betting they’ll tear each other apart arguing over details while they do it. Life is easy when all you have to do is yell “Repeal Obamacare!” but it gets a lot harder when you have to produce an actual plan.

And as expected, Rick Perry folded like a cheap suit.

Perry said Obama’s flexibility “doesn’t address the structural flaws” with the health care overhaul that confronts state executives with federal mandates to provide multibillion dollar shares to provide Medicaid coverage to the poor — a requirement that many GOP governors complain will squeeze state budgets.

Perry, who also serves as chairman of the Republican Governors Association, said he was “disappointed” by Obama’s gesture because it falls short of GOP governors’ effort to win federal block grants with no strings attached to implement their own measures to provide health care coverage to the poor.

“Pretty much all he did was kind of reset the clock on what many of us consider to be a ticking time bomb that is going to absolutely crush our state budgets,” Perry told a news conference. “The states need more than that. We need some tough principled decisions of the sort that address the real budgeting issues that we have.”

Perry said that governors’ resistance to Obama’s health care overhaul had “put the administration on its heels” as state executives demand greater flexibility to adapt required coverage that is paid for by states.

You will note that the one thing Perry did not say was “Of course we states can do it better than the federal government can! Just get out of our way and watch us!” That would be because he has no plan to improve access to health care – quite the opposite, in fact – he has no intention of ever coming up with a plan to improve access to health care, and would really like it if things went back to how they were during the first eight years of his reign when nobody was making him talk about improving access to health care. He knows he can’t do it, he doesn’t want to try, and he’s desperately hoping for a bailout from the Supreme Court to get him off the hook. The same is true for all of his Republican Governor colleagues, and he knows that as well. It’s easy to see why that swagger of his can disappear in such a hurry.

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