At the recent governors’ meeting on the Hill, the president appeared to offer some sort of appeasement to GOP chief executives in the group who were concerned about just how far they had to go to accommodate the mandate provision of coverage once reform was fully in play by mid-decade. He may have been thinking that he was doing them a favor by increasing “flexibility” in the pending rules as dictated by the reform law. But, those critics on the right were quick to jump on the anti-assist bandwagon — criticizing the Obama for allowing them to institute the types of reforms that they prefer. Obama’s olive branch would have allowed concerned states to apply for a waiver to three years earlier (2014) to provide alternative delivery mechanisms rather than wait to do so, as originally designed under the reform law — the caveat being the alternative: insuring just as many patients, doing it at no extra cost to taxpayers, and making sure the coverage was just as comprehensive. With his seemingly innocuous words on the matter, Obama has managed to thrust the reform law debate into a new light. We all know that reform will occur (it’s already law) — now, it is evident that its detractors are scrambling for ways to modify its implementation. At the moment, for example, some Republican governors are using the debate on constricted Medicaid coffers to drive home the possibility of privatizing care under reform for those who do not qualify for Medicaid — under the rubric of “consumer-directed care savings accounts”. Like the debates on Social Security privatization that preceded the debate on health reform, it may be too early to see if this latest anti-reform law salvo is durable; but it is already proving to be problematic for those who envision greater quality of care at a reduced cost of delivery.