Insurers could operate in vastly different marketplace conditions across the country when the Affordable Care Act's "state innovation" provision goes into effect in two years. That's because the ACA includes a waiver allowing states to use federal dollars to redesign their own healthcare systems--without Congressional approval, reported the Associated Press.
States could take hundreds of millions of dollars in funds from federal subsidies and, for example, eliminate or change penalties for uninsured people and large businesses that don't provide health coverage. States also could modify insurance benefits and subsidies, such as by finding different ways to subsidize premiums for their residents. Plus, states could alter health insurance exchanges or eliminate them altogether.
So far, state officials in Hawaii, New Mexico, Minnesota and Vermont have expressed interest in these waivers.
The specific changes that insurers see will depend on whether a Democrat or Republican is elected as next president. A Democratic president likely would use the waivers to reach out to Republican governors and legislators who have opposed the ACA, while a Republican president might see the waivers as an opportunity to amend the ACA without completely dismantling the law.
"Whoever is in the White House in 2017 and beyond is going to have a lot of flexibility without having to change the [ACA]," Stan Dorn, a health policy expert at the nonpartisan Urban Institute, told the AP.
The state innovation provision, however, prohibits states from repealing certain key elements of the healthcare reform law, including requiring insurers to cover high-risk consumers with health problems. The ACA states that insurers cannot discriminate against individuals with certain medical conditions, FierceHealthPayer previously reported. States also would have to continue covering about the same number of people while providing comprehensive benefits and financial security against harmful costs, the AP added.
To learn more:
- read the AP article