4 ways state innovation waivers can't deliver on promise of reform

Though state innovation waivers allowed under Section 1332 of the Affordable Care Act look like a promising way for states to dismantle some components of the ACA, actually doing so is not as simple as it seems, according to a Health Affairs Blog post.

Such ACA alternative plans are generally required to provide coverage that's at least as comprehensive and affordable as those under the health law, cover a comparable number of residents and not add to the federal deficit, the post noted. Guidance released in December from the Department of Health and Human Services and the Department of the Treasury further says those departments will assess how those proposals affect vulnerable residents, as FierceHealthPayer previously reported.

As a result, several proposals that seemed to have promise have little chance of succeeding, according to the post. Those include:

  • Eliminating either the employer mandate or the individual mandate, both of which would reduce federal revenues.
  • Waiving essential health benefits, which would require states to prove that won't reduce the number of residents with coverage that is at least as comprehensive.
  • Allowing subsidies outside the ACA exchange, which would increase federal spending on premium tax credits and cost-sharing reduction subsidies.
  • Expanding subsidies to people with access to employer-sponsored insurance, which, again, would increase federal costs.

"Without flexibility in cost-sharing, coverage or enrollment, it is difficult to see what room for meaningful change remains outside of the kind of single-payer system that attracted Vermont and Colorado to Section 1332," according to the post, "unless states are willing to take on higher risks and increased costs in order to obtain a waiver."

To learn more:
- here's the post