President Obama made a strong push for support of the Affordable Care Act (ACA) at the National Governors’ Association (NGA) conference in Washington last week. I was on a call with some other health care leaders arranged by the White House before Obama visited the NGA to test out the recommendations he planned to make there. Obama had decided to suggest that the 50 states consider applying for HHS-certified state “waivers” from the ACA, as the law is currently to be implemented nationally. This is kind of a radical change in the administration’s position.

Most states are moving ahead with ACA implementation as provided in the Act. But the President’s unexpected push at NGA for “state model ACA waivers,” in accordance with the Wyden-Brown “Empowering States to Innovate Act,” might make some Republican critics a little more hopeful about the ACA; while annoying the left-leaning Democrats. The President's push for the waivers is another sign that he is moving toward the political middle, where most Americans are more comfortable (me included).

In addition, Obama is recommending that the Wyden-Brown act be amended to be effective in 2014, instead of the current version, effective in 2017. This will make Wyden and Brown ecstatic; and may swing some Republican-leaning states to get more involved. Some left-leaning states as well it seems.

Any state model must meet the basic standards of the ACA—meet the access and affordability standards without adding to the national deficit. A proposed set of regulations on how states can comply will be issued in the next few months.

Meanwhile, Florida Judge Vinson, who found the ACA unconstitutional, was pressed by Obama to interpret his decision -- did he want an injunction to halt implementation or not? He surprisingly said the act could be implemented until the appeal of his decision is completed. Some media sources hailed that as a huge victory for the Administration……. It wasn’t. Vinson expects the appeal process to be expedited at the next level (Federal Circuit Court of Appeals) in as short a time as a week. He still wants the law stopped (of course, the appeal may not happen that fast, and it will likely go to the Supreme Court no matter what).

Of course, the Republicans in Congress also hope to use the budget impasses to prevent the ACA from incrementally going forward by de-funding HHS. But most states are still moving ahead anyway, assuming the law will eventually prevail.

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