First, lawmakers can give states greater flexibility on the scope of health benefits that plans must provide. The law now requires that state waivers establish plans to provide coverage that is as “comprehensive” as that provided for under the law’s essential health benefits requirement. But some states may wish to mandate coverage of a different set of benefits than that specified, or choose to minimize the benefits that plans are required to cover. It is unclear, at best, whether this would be permissible under current law. Congress could either clarify what is meant by “comprehensive” in Section 1332 or, more helpfully, simply specify that states have greater flexibility in determining the benefits that must be covered.

These changes would not permit states to eliminate the A.C.A.’s protections for those with pre-existing health conditions nor allow them to introduce differential pricing for health plans based on health status.

Second, Congress can make it easier for states to put their own reform plans into effect and narrow the discretion given to the administration to approve or deny waiver applications. Lawmakers could do this by deeming waiver applications presumptively valid, so long as they certify that a similar number of people will be covered and at a comparable level of affordability as under the law and that the state reforms will not increase the federal deficit. This would apply regardless of whether an application comes from a progressive or conservative state. Vermont, for example, considered a Section 1332 waiver to install a single-payer health system but stopped because it could not come up with a funding mechanism to support the plan.

Federal authorities would then be responsible for evaluation of the state’s reform plan as soon as six months after the waiver is approved and on an as-needed basis thereafter. States not meeting thresholds of affordability or the number of people covered would then be required to adjust their reforms accordingly.

We are on the cusp of a rare health care bipartisan agreement. Still, conservatives will (and should) insist on fundamental reforms to Obamacare as part of the deal. In so doing, they should aim for an approach that will truly give more states the opportunity to become what Justice Louis Brandeis once called the “laboratories of democracy.”