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Jay Evensen - What Really Counts When Getting Waiver from Washington?

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The Obama administration has granted more than 1,000 waivers to the Affordable Care Act, or "Obamacare," since it was enacted. Waivers have been granted to other laws, as well. But this might lead you to believe that getting a waiver out of Washington is easy.

That's not necessarily true if you're a state, and perhaps especially so if you're one with a Republican majority.
Utah officials wanted to go paperless in the way it corresponds with Medicaid recipients. Those who voluntarily agreed to go along would begin receiving items by email rather than through the U.S. Postal Service. This violated rules by the Centers for Medicaid and Medicare Services, which said all communication had to be by paper.

Officials estimated email would save the state $6.3 million a year. It could save the nation $600 million to do such a thing in all 50 states, but that's beside the point. Such money is the equivalent of getting rid of the pennies in your wallet, but you would think even that would help a nation that qualifies for debt counseling.

Gov. Gary Herbert told the Deseret News editorial board last week that the state spent the better part of a year working with federal officials, only to have the waiver request to use emails rejected.

"We got a denial from the Department of Health, and it was sent to us by email," Herbert said, adding in exasperated postscript,
"So … just the irony."

The governor tried a different, rather ironic approach of his own a while later when he spoke with the president during a meeting of the National Association of Governors in Washington.

"Hey, I've got an idea, what do you think?" he asked Obama, explaining how Utah felt it could save money by going paperless.
As Herbert recalls, Obama said, "It sounds like a good idea to me."
"I says, "Well would you tell your Department of Health, because they just turned us down on this good idea.' "

Later that day, Herbert received word from HHS Secretary Kathleen Sebelius that the department would work with the state to grant its waiver. This time, the communication came by way of a handwritten note.

This, the governor said, exemplifies the challenges of dealing with Washington.

"We've got some ideas here. We'd like to experiment. We'd like to try them out. We are laboratories of innovation. That's part of the beauty of federalism."

Thus is illustrated one of the main issues up for consideration this November. Who knows best, people who run states or people who run the federal government?

The answer is that neither possesses any innate superiority of intellect. But one group knows the unique needs of the people who live within its geography. And even if geography is set aside, the collective ideas of 50 governments with the same goal ought to be superior to the ideas of one.

While the governor was discussing his efforts to obtain waivers concerning Medicaid, a political fight was breaking out between the president and Republican candidate Mitt Romney over waivers of a different sort. Romney's camp was accusing Obama of proposing waivers that would change the work requirements outlined in the welfare reform law President Clinton signed in 1996.

This time, the roles were reversed. Republicans were against the waivers, while Sebelius was quoted as saying it is important to allow states to see whether they could experiment to make the program better.

Utah was involved in this one, too. The administration said Utah was one of the states requesting a waiver, to which Herbert's spokeswoman said yes, but not concerning work requirements.
There is an arrogance underlining both these discussions.

In a story published by The Hill earlier this year, a spokeswoman for Health and Human Services said some waivers regarding health care were denied because they "did not demonstrate that compliance with the minimum annual limits requirements would significantly increase premiums or decrease access to benefits."

That's bureaucratic nonsense. When it came to Utah's Medicaid waiver, other factors must have been involved. Perhaps the biggest was that the federal government will sometimes reject waivers simply because it can.


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