[Congressional Record Volume 157, Number 14 (Tuesday, February 1, 2011)]
[Senate]
[Pages S417-S418]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WYDEN (for himself, Mr. Brown of Massachusetts, and Ms. 
        Landrieu):
  S. 248. A bill to allow an earlier start fof State health care 
coverage innovation waivers under the Patient Protection and Affordable 
Care Act; to the Committee on Health, Education, Labor, and Pensions.
  Mr. WYDEN. Mr. President, I rise today to reintroduce the Empowering 
States to Innovate Act with my colleagues, Senators Scott Brown and 
Mary Landrieu.
  At a time when we are looking for ways to bring this country together 
to deal with the most contentious issues of our time, we ought to be 
supporting innovation. We ought to be supporting unleashing creative 
kinds of approaches to deal with domestic issues. That is the 
foundation of this legislation.
  What Senators Brown, Landrieu and I are seeking to do is to show it 
is possible on a significant issue--I think we all understand health 
care is about as important as it gets--that we can come together, and 
facilitate this kind of innovation. It is pretty clear that what works 
in Springfield, OR, may not be exactly ideal for Springfield, MA. But 
what we can do is come up with a way to provide more flexibility and 
particularly more choice and more competition for our States and other 
States around the country.
  If we can just move away from a Federal cookie-cutter approach and 
encourage the kind of creative thinking we have seen in Oregon and in 
Massachusetts and other parts of the country, I think we will be well 
served and will be in a position to better contain health care costs. I 
think we all understand that how to rein in these medical costs that 
are gobbling up everything in sight is first and foremost on the minds 
of our constituents.
  The Empowering States to Innovate Act encourages additional 
innovative approaches in States, approaches that are tailored to the 
needs of States' own residents, that will help us, in my view, to 
promote choice and competition in the American health care system. As 
long as they meet certain requirements as far as coverage and 
affordability are met, the States are free to do whatever they choose. 
I just offer up my own judgment that right now, at a time when most 
Americans still don't get much choice in their health care coverage, 
this is an ideal opportunity that both Democrats and Republicans can 
support. As States seek to go forward with this approach, they can make 
their own choices.
  In particular, what I have been concerned about, after talking to 
health policymakers over the last few months, is if, in the State of 
New York, for example, you go out and set up a process to comply with 
the legislation for purposes of 2014 and you see that the waiver, as 
now constituted under 1332, starts in 2017, you say: How am I going to 
reconcile those two? Am I going to set up one approach for 2014 and 
then do another approach in 2017? It is going to put us through a lot 
of bureaucratic water torture to try to figure out how to synchronize 
those two dates. So it only makes sense to speed it all up and make it 
possible for everybody to get started in 2014.
  We have outlined the two key changes in the legislation that is law 
today. The first change is to make the waivers effective in 2014 rather 
than in 2017 so States only have to change their systems once. The 
second thing the Empowering States to Innovate Act does is it requires 
the Department of Health and Human Services to begin to review State 
waiver applications within 6 months of enactment of the legislation. 
This would allow States early notification of whether their State 
waivers have been approved and would give them adequate time to roll 
out their State-specific plans. I think this, too, will help us create 
more competition, more choice, and more affordability in American 
health care because it will give the States adequate time to gear up. 
That is the philosophy behind the Empowering States to Innovate Act, 
whether one likes one particular approach or another. Clearly, there 
will be great diversity of approaches tried at the State level.
  This legislation offers an opportunity for States to engage in a 
``race to the top'' for what will deliver the best health care choices 
and options to their constituents. This provides a chance for States to 
do it better. I look forward to working with colleagues on both sides 
of the aisle to give States that chance.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 248

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Empowering States to 
     Innovate Act''.

     SEC. 2. EARLIER START FOR STATE HEALTH CARE COVERAGE 
                   INNOVATION WAIVERS.

       Section 1332(a) of the Patient Protection and Affordable 
     Care Act is amended--
       (1) by striking ``January 1, 2017'' in paragraph (1) and 
     inserting ``January 1, 2014''; and
       (2) by inserting ``beginning not later than 180 days after 
     the date of the enactment of the Empowering States to 
     Innovate Act'' after ``application'' in paragraph (4)(B)(ii).

  Mr. BROWN of Massachusetts. Mr. President, I rise today to join my 
colleague, Mr. Wyden, to introduce legislation that will protect 
Massachusetts by allowing it to waive out of specific requirements 
under the Patient Protection and Affordable Care Act.
  As my colleagues know, my single priority is and has always been to 
ensure that what we do here in Washington does not harm my State of 
Massachusetts, or the people of Massachusetts, and that we are 
responsible stewards with every tax dollar.
  This has been true when it comes to voting against raising taxes on 
families and businesses. It has been true when it comes to fighting for 
commonsense, progrowth policies that will create jobs in Massachusetts. 
And it has been true in my efforts to be sure that the Federal health 
care reform bill does not diminish or harm the health care innovations 
that have occurred in Massachusetts.
  Today we get to make a correction to the Federal health care reform 
bill to be sure that we are doing the right thing, not just for the 
State of Massachusetts but for other States who seek to waive out of 
certain requirements of the Federal health care reform law.
  In many ways, Massachusetts has been on the forefront of implementing 
health care reform--expanding access, designing systems to increase 
market participation and choice, and increasing transparency for 
consumers and providers. We continue to learn lessons every day in 
Massachusetts about what works and doesn't work in health care reform.
  And this is an important point because it speaks directly to the 
purpose of the 1egislation that I am introducing today with my 
colleague, Mr. Wyden from Oregon.
  As difficult as it is for me to admit this, not every State wants to 
be like Massachusetts. Massachusetts is a great State, with the best 
hospitals, physicians, researchers and health care providers in the 
country and the world.
  But I recognize that my colleague from Oregon is interested in 
protecting the reform efforts of Oregon. He doesn't want to be like 
Massachusetts because Oregon is different from Massachusetts. Oregon's 
insurance market is different, its provider network is different, its 
beneficiaries and population are different from Massachusetts. Oregon 
might want to implement reforms or create a coverage mechanism that I 
do not like or that would not work in a State like Massachusetts. The 
same is true for the other 49 States--each State is different, unique--
and each State should be able to find solutions that work for their 
citizens and their State budgets.
  Which is why the legislation that I am introducing today with Mr. 
Wyden--the Empowering States to Innovate Act--is so important.

[[Page S418]]

  Right now, as provided under section 1332--``The Waivers for State 
Innovation''--of the Patient Protection and Affordable Care Act, States 
can waive out of provisions of the Federal reform law. That's the good 
news. The bad news is that this waiver authority is not scheduled to 
take effect until 2017, a full 3 years after PPACA is scheduled to be 
fully implemented.
  That makes no sense, so we are going to fix it.
  The first thing our bill does is to allow States to waive out of 
specific parts of PPACA in 2014 rather than 2017. This makes sense not 
just from an operational standpoint--because PPACA takes effect in 
2014--but also from an economic and fiscal standpoint. Why should 
Massachusetts be delayed in obtaining a waiver from the Federal reform 
bill when it may have already met and or exceeded specific provisions 
of PPACA? Holding Massachusetts back--limiting my State's ability to 
innovate, remain flexible and responsive to the health care market-- 
costs money; it costs taxpayer money.
  That doesn't make sense. So our legislation fixes that.
  The second piece our bill does is to provide States with certainty 
with the waiver process. Not every State will be eligible for a waiver 
and not every waiver will be granted. But our bill provides some 
certainty for those States who apply for a waiver by requiring the 
Secretary of Health and Human Services to begin reviewing applications 
within 6 months of enactment of this bill. The earlier a State knows 
whether it has received a waiver, the earlier it can begin implementing 
its specific plans and proposals.
  Taken together, these two changes are good for Massachusetts. They 
are good for other States who are trying to innovate and advance in the 
areas of health care reform, cost containment, and coverage.
  During Wednesday's Finance Committee hearing, Dr. Berwick, who is 
from the State of Massachusetts, I might add, said this about State 
innovation and flexibility.
  And I quote:

       The cliche about states as laboratories of democracy is not 
     just a cliche, it's true. The diversity of approaches that 
     we're seeing emerge state by state has been there for a long 
     time. I think we should be doing everything we can to 
     encourage it.

  I couldn't agree more. I am a strong supporter of state rights and 
for allowing States to solve problems without the Federal Government's 
interference.
  We should be encouraging State innovation, not hampering it.
  And that is what the Empowering States to Innovate Act does--it helps 
ensure that States aren't held back from innovating and seeking 
solutions that work for their citizens, their taxpayers, their 
providers, and their communities.
  Finally, Mr. President, I want to associate myself with Mr. Wyden's 
comments about how our bill fits into the Federal health care reform 
debate. Enacting this legislation is the right thing to do because it 
is good for States like Massachusetts. It is good for States like 
Oregon and Utah, who have begun to make changes and reforms at the 
State level.
  The legislation provides flexibility and says that a one-size-fits-
all health care system doesn't fit the needs of every State. I know a 
Federal standard isn't in the best interest of my State of 
Massachusetts, which is why passing this bill is the right thing to do.
  I thank my colleague, Mr. Wyden, for his thoughtful remarks and urge 
my colleagues to join us in supporting this legislation that I think 
both parties can and should agree on.
                                 ______