Despite a year of sustained attacks from the opposition, almost all states continue to move forward with implementation of the health care law. Even as the right continues to spew rhetoric attempting to strike down the law, over 20 states  are moving forward with active exchange legislation. As the time remaining for states to implement effective exchanges grows shorter, and as an effort to give states more freedom to design their own systems gained White House support this week, progressive models are emerging for building state-based marketplaces that ensure the health security of families.
Some states emerging as leaders are Washington, Oregon, and Connecticut, each of which has taken a different approach to implementation based on their states’ existing political, legislative, and administrative realities. Before acting on legislation, the state of Oregon  assembled task forces on key issues to drive a health action plan that included budgetary recommendations surrounding the $3.5 billion deficit in the state. In Washington, a menu of health options had already been in place based on an existing health insurance co-op  and strong consumer protection provisions in exchange governance legislation. And Connecticut is building on their current system, bringing many of their programs such as the state’s Husky plan under an exchange umbrella called Sustinet .
This week, the White House backed an effort to give states even more power by supporting the Wyden/Brown bill to allow states to receive waivers for early innovations in developing their own health care programs starting in 2014, rather than in 2017 as the Affordable Care Act (ACA) provided. If passed, this measure would allow states that want to enact single-payer or a public option to have the flexibility to do so, as long as they met the same basic federal requirements of the ACA -- including coverage and cost. This would mean states like Vermont , where the governor has already announced a plan for a single payer structure, could go forward more quickly and efficiently. It would also, of course, mean that states with legislatures and governors’ offices currently controlled by conservatives would be faced with the steep challenge of developing and introducing their own plans that meet both the goals and the cost of the ACA.
Many progressive state advocates are supporting the bill because of the opportunity it provides for people in the states to know and assess their own situation and be able to put into place measures that will best serve their constituents. Right now, the bill would affect only a limited number of states already on their way to more progressive measures , including Vermont, California, Oregon, Washington, Connecticut,and Hawaii. Yet there is hope the bill may also encourage other states currently teetering on advancing progressive measures or building on the current systems they have in place to move forward more boldly on enacting progressive state health systems.
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Washington Post - "White House comes out for Wyden-Brown state waiver program" 
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