WASHINGTON — Offering to be more flexible on implementing the new health care law, President Obama called Monday for letting states move sooner to develop alternative plans for meeting its goals — including expanding coverage.
While maintaining his insistence on achieving the law's aims, Obama said he was willing to allow governors to propose their own strategies as early as 2014, instead of waiting until 2017 as the current law provides.
"If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act does, without increasing the deficit, you can implement that plan," Obama told governors gathered at the White House. "And we'll work with you to do it."
The law allows states, starting in 2017, to seek waivers from requirements such as the mandate that all Americans get health coverage as long as they showed that their alternatives would deliver the same benefits — for consumers and for the budget.
Obama's offer — which drew swift criticism from several Republican officials — underscored the intensifying cat-and-mouse game that the administration is playing with Republicans over health care as the 2012 presidential election cycle begins.
Republican officials nationwide are stepping up their criticism that the law does not give states enough freedom to design their own solutions to the nation's health care crisis.
The GOP now controls 29 governorships, up from 23. Most of the states they govern have joined lawsuits challenging the law's constitutionality.
Responding to the new political reality, the Obama administration has begun highlighting its responsiveness to state needs without yielding on the basic elements of Obama's signature domestic policy achievement.
"I am not open to re-fighting the battles of the last two years, or undoing the progress that we've made," Obama warned his critics Monday.
The law already gives states substantial authority to design their own systems, including setting up and regulating their own insurance markets.
Under the proposal Obama endorsed, which must be approved by Congress, states might design a program that would expand coverage for lower-income people using private health insurance instead of relying heavily on the government Medicaid program, as the health law does.
Or it might allow a state to develop an alternative to the controversial individual insurance mandate that will penalize Americans who don't get insurance starting in 2014. Other countries use different mechanisms to encourage healthy people to get insurance.
It might even allow some traditionally liberal states, such as Vermont, to explore single-payer systems for expanding coverage.
"The president is serving it up to the governors on a plate," said Sen. Ron Wyden, D-Ore., who co-authored the waiver proposal with Massachusetts Republican Sen. Scott Brown.
J. Fred Ralston Jr., president of the American College of Physicians, expressed hope Monday that the proposal "could provide a basis for much-needed bipartisanship."
States would not be able to eliminate consumer protections in the law, such as the requirement that insurers offer coverage to people regardless of their health.
And states would still have to ensure that insurers offer a minimum set of benefits to be set by the federal government, another key requirement of the new law.
It remains unclear how many states would seek the waivers, or if Republicans on Capitol Hill would even back legislation to give states the option. There are no current plans to vote on the proposal, which would require Congress to change the existing law.
GOP governors are already pressing the administration for permission to cut some people off Medicaid, saying they cannot afford to maintain current coverage levels.
Secretary of Health and Human Services Kathleen Sebelius has approved a request from Arizona to pare its program. And the administration is offering help to other states looking for ways to hold together their budgets as they struggle with providing health care to millions of unemployed workers.
But Republican officials — who continue to push for a full repeal — have dismissed many of these overtures and called the president's new offer a publicity stunt.
"I was disappointed," Texas Gov. Rick Perry said. "Pretty much all he did was reset the clock on what many of us consider to be a ticking time bomb that is absolutely going to crush our state budgets. The states need more than that."