President Clinton built the Welfare Reform Act of 1996 on President Reagan’s strategy of granting waivers to states, allowing them to experiment with various alternatives but holding them accountable for results. Waivers allocated to governors from both parties catalyzed state innovation and produced empirical evidence about what worked — and what didn’t.
By 1996, while hotly contested in D.C., the public debate in the states was over: Citizens across the country had seen and read about these reforms and understood them. Romney should propose another “great experiment,” setting clear goals and granting states the flexibility to innovate based on their unique market structures and populations.
The federal health care law is doomed to fail either in the court of law or in the court of public opinion. If we are given a second chance, Romney would be wise to articulate federal fixes to the unfair federal tax preference for employer-based insurance and the problem of Americans with pre-existing conditions being unable to purchase affordable insurance. But he should resist the D.C. impulse to fix the whole problem, instead setting measurable goals and holding states accountable for innovating and delivering results.
Jim Stergios is executive director and Josh Archambault is director of health care policy at the Pioneer Institute in Boston, publisher of “The Great Experiment: The States, The Feds and Your Health Care.”