Thanks to a little-known provision of the Affordable Care Act, policy changes that could ultimately lead to a single-payer system might be much more viable than previously thought.
By using Section 1332 of the ACA, Hillary Clinton would not need further congressional approval to implement a "public option," Scott Gottlieb, M.D. resident fellow at the American Enterprise Institute, writes in an op-ed for the Wall Street Journal. That, he says, could further progressives' goal of creating a single-payer system, as Bernie Sanders has recently advocated.
It's past time we joined every other major country on earth and guaranteed health care to all as a right, not a privilege.
— Bernie Sanders (@SenSanders) August 16, 2016
Related: Single-payer insurance might efficiently allocate US healthcare spending
Section 1332 of the law sanctions state innovation waivers that allow states to renounce nearly all of the law’s controversial dictates--provided the state proposes an alternative that:
- Enrolls a comparable number of people as the ACA
- Offers plans least as comprehensive and affordable as those sold on ACA exchanges
- Doesn't add to the federal deficit
- Doesn't disproportionately harm vulnerable populations
While some Republican states have looked to Section 1332 as a way to bypass the ACA’s requirements, there may be little room for meaningful change outside of a single-payer system, FierceHealthPayer has reported.
“The real juice is the funding,” Gottlieb writes. Under Section 1332, states would be able to use federal dollars earmarked for consumer subsidies and tax credits, and small-business tax credits, to finance a publicly run health plan, according to Gottlieb.
Minnesota, for example, is proposing to use the state’s current Medicaid price schedule to set rates for its proposed public option, the op-ed notes. Maine, Rhode Island and Colorado are considering similar variations of this model for implementation after 2017.
If providers have to accept Medicaid-like rates, public option plans could become cheaper than many existing ACA plans, Gottleib adds. A federally subsidized but state-administered single-payer healthcare system could be the next logical step in the progression of state innovation waivers.
Still, no state has yet successfully implemented a public option or single-payer plan, and not for a lack of effort. Vermont tried to roll out a single-payer plan, but Gov. Peter Shumlin pulled the plug on "Green Mountain Care" in December 2014 after facing difficulties financing the plan.