My latest column for Kaiser Health News:

With Republican governors complaining that the Affordable Care Act doesn't give them enough flexibility, President Barack Obama on Monday offered a compromise: He'd allow them to opt out of the law altogether, just as long as they had an alternative method of providing universal coverage.

Although a few Republican governors responded positively, the party's more visible leaders were quick to condemn the move as meaningless. "Flexibility," quipped Senator Orrin Hatch, a Republican from Utah, "I believe the technical legal term is baloney." Conservative intellectuals agreed. Obama's proposal is "not an actual concession," according to National Review's Yuval Levin, because "it would allow conservative-leaning governors essentially no freedom to move in the direction of greater competition and more consumer-driven health care."

Hatch, Levin and the other critics of Obama's proposal have a point: It wouldn't allow them to enact the sorts of health care reforms they would prefer. But that's because their proposals wouldn't come even close to making health care affordable for all Americans. The real problem here, in other words, isn't the lack of flexibility in the health law. It's the lack of workable ideas from critics on the right.

The actual change Obama proposed is, to be sure, modest. Under the Affordable Care Act, states are responsible for creating exchanges (the marketplaces where individuals and small-businesses can buy coverage) as well as implementing other key aspects of reform. That work must be done by 2014. The law allows states to opt out of the scheme, by getting a special waiver from the federal government, as long as they have alternative means for achieving the measure's mandated goals. But states can't do that until 2017.