1332 Waivers

As I've explained before, Section 1332 of the ACA itself gives individual states the right to petition to make changes in how the law works in their state. The idea is that, as President Obama noted himself, if a state can come up with ways to make the ACA provide coverage which is at least as comprehensive to at least as many people as it already does, without increasing the federal deficit, go for it.

There've been a couple dozen 1332 waivers which have made it at least partway through the development process; some failed along the way, some were completed but then rejected by CMS, and some have been approved. The most common type of approved 1332 waiver, in nearly a dozen states now, is for reinsurance, which is a wonky way of leveraging state dollars to reduce premiums for unsubsidized ACA enrollees.

If you're wondering why you've only heard about "reinsurance waivers" over the past year or two, there's two reasons.

Last fall I wrote about Yet Another Sabotage Attack® on the ACA by the Trump administration, this time in the form of CMS Administrator Seema Verma completely warping the entire point behind the 1332 Waiver provision. Here's the backstory:

One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

 

A month ago I posted a Red Alert about the latest regulatory attack on the ACA...this time coming directly from CMS Administrator Seema Verma. At the time, Verma had just announced a draft version of the new rules for Section 1332 Waivers...starting with changing the name from "State Innovation Waivers" to "State Relief and Empowerment Waivers", which sounds in no way like Orwellian doublespeak propaganda.

Here's the basic backstory on 1332 waivers:

One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":

 

One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

State Innovation Waivers allow states to implement innovative ways to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state as would be provided coverage absent a waiver, and does not increase the federal deficit.