ACA waivers offer opportunity to expand premium assistance

Some of the more flexible provisions of the Affordable Care Act, such as State Innovation Waivers, have the potential to revitalize the concept of health insurance premium assistance, according to a recent Health Affairs Blog post.

In the past, premium assistance was confined to helping a small portion of Children's Health Insurance Program and Medicaid recipients afford their employer-sponsored coverage. But now, the ACA has expanded the population eligible for assistance considerably by offering two main options:

  • The Health Insurance Premium Payment program (HIPP), in which the government pays for employees' share of coverage through their companies
  • A recent application of Section 1115 demonstration waivers known as the "private option," which uses Medicaid funds to pay for individuals' private health insurance and copayments

Indeed, waiver programs have especially appealed to Republican-led states that seek alternatives to traditional Medicaid expansion, FierceHealthPayer has reported. Some programs, such as the one in Indiana, require beneficiaries to contribute a small amount to their monthly premiums.

The State Innovation Waiver provision, meanwhile, "gives the traditional HIPP program new life" by allowing states to come up with alternatives to some of the ACA's core policies such as the individual mandate or premium tax credits for qualified health plans.

For instance, if a state decides to combine a Section 1115 Waiver with a State Innovation Waiver, it could design a premium assistance program for residents who can't access subsidies because of the ACA's so-called "family glitch," which arises because a family can't receive premium tax credits if a member is eligible for employer-sponsored coverage that meets the affordability standard.  

Similarly, a "three-share" premium assistance program between the employee, employer and government has the potential to cut down on individuals' tendency to switch health plans and types of coverage.

Overall, the concept of premium assistance may be the answer for states that want to design programs to offer their residents greater access to coverage "while remaining true to their public policy principles," the post concludes.

To learn more:
- here's the post

Related Articles:
Medicaid expansion roundup: Waiver programs gain steam in GOP states
Montana's Medicaid proposal may face scrutiny from CMS
Indiana's Medicaid program paves way for other states
HHS: 'Limited number' of states can privatize Medicaid expansion

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