Across the country, state-based advocates are trying to inject more flexibility into the federal health reform law, so that states such as Vermont and California are free to set up a single–payer universal health care system.

They have now received support from Senators Wyden and Brown who introduced the “Empowering States to Innovate Act” (S. 3958) (see below). This bill would “allow an earlier start for State health care coverage innovation waivers under the Patient Protection and Affordable Care Act.” Under PPACA, states must set up market-based insurance exchanges by 2014 (or the federal administration will do so for them), and they cannot apply for a waiver to try a different system, such as a public single–payer system, before 2017. The bill would move this date forward to 2014.