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Just Released
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New 1332 Waiver Guidance Makes it Easier for States to Use ACA
Waivers To Help Healthier People Buy Short Term Plans That May Not Cover
Pre-Existing Conditions
Recent Trump
administration guidance gives states more flexibility in Affordable Care Act
(ACA) waiver proposals, opening the door for interested states to shift
federal subsidies to insurance plans that do not comply with the health law,
according to a new analysis from KFF (the Kaiser Family Foundation).
It also could enable states to restructure ACA
subsidies in ways that provide less help to people with low incomes or high
health care needs and more help to those not currently eligible for such
subsidies, including higher income and younger people with fewer health needs
who may opt for non-ACA compliant short term plans. Waivers have to be budget
neutral for the federal government, meaning that greater subsidies for some
groups of people necessitate lower subsidies for others.
Such changes to so-called “1332 waivers,” if
states choose to implement them, could affect the stability of the ACA’s
private insurance marketplaces by allowing federal funding for premium subsidies
to flow to short-term insurance plans that do not comply with the ACA’s
rules, the analysis finds.
ACA Section 1332 waivers allow states to
experiment with strategies to provide health coverage that delivers at least
the same level of protections guaranteed under the health reform law to at
least as many people. The Trump administration released the new guidance on
October 22, replacing guidance issued in 2015 by the Obama administration and
substantially changing the standards for evaluating applications for such
waivers. To date, 1332 waivers mostly have been used to implement reinsurance
programs that reimburse insurers for certain high cost claims in order to
lower premiums overall in the individual insurance market.
On November 29, the Centers for Medicare and
Medicaid Services outlined a set of waiver concepts designed to provide
states with a roadmap for developing 1332 waiver applications that use the
new flexibility. This KFF issue brief describes the new guidance and how
state waiver activity may change, and examines possible implications of the
changes.
Filling
the need for trusted information on national health issues,
the Kaiser Family Foundation is a nonprofit organization based in San
Francisco, California.
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Monday, December 10, 2018
New 1332 Waiver Guidance Makes it Easier for States to Use ACA Waivers
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