Obama's is back to pretending to be flexible on health care reform. He is saying that states can opt out of the provisions of his health care reform, but only if they mandate the kind of comprehensive health care prepayment model of Obamacare. So you can have your government-run medicine with ketchup or mustard - cause he is all about flexibility.
Obama wants to seem a lot more reasonable and open minded then he is. One of his strengths is his ability to project moderation in service of leftism. I think the best way for conservatives (and especially conservative governors) to shatter his facade of moderation is to take him at the moderate tone rather than the recalcitrant fine print of his remarks. You want us to be flexible? We are going to implement HSA/catastrophic coverage for public sector workers. We are going to convert our states' Medicaid programs into a voucher for high deductible insurance. We are going to use the flexibility you say you want us to have to transform our states' health care markets. We aren't even going to ask permission first.
This approach has the advantage of boxing Obama in. If Obama chooses not to fight these changes then the number of Americans on consumer-driven polices will increase and thereby make the full implementation of Obamacare that much harder. If Obama chooses to fight these policy changes then he can explain "Well, when I said flexibility, I meant flexibility to implement single-payer not free market-oriented health care." Republicans can then attack him for dishonesty while pushing a positive program that would save the government money and increase the take home pay of a significant subgroup of American. Not only does Obama's image as a moderate take a hit, but conservatives can also use the argument to increase public awareness of, and support for, market-oriented alternatives to Obamacare.