ACA Waivers Could Open Door To Insurer Opportunity

By Susan Rupe

States that want to do the ACA their way -- including a single-payer system -- may get their chance under a new rule issued this week.

The innovations may offer insurers an opportunity to offer new products, such as private insurer involvement with Medicaid, according to Gretchen Harders, a partner in Epstein Becker Green, a national health care and labor law firm.

The U.S. Department of Health and Human Services published guidance this week on state innovation waivers described in the ACA. The waiver would permit the state to pursue innovative strategies for providing their residents with access to health insurance while keeping the ACA’s basic provisions.

Waivers are available beginning Jan. 1, 2017, and are approved for five-year periods.

Under Section 1332, states can request that HHS waive certain ACA provisions, including those that relate to federal health care subsidies, health insurance marketplaces, the individual mandate and shared responsibility requirements for employers with 50 or more full-time workers.

However, the states seeking a waiver must ensure that a comparable number of people would continue to be covered as would be under the original provisions of the ACA. They must ensure that health coverage provides benefits that at least equal the “essential health benefits” under the ACA. They must provide cost-sharing protections to make coverage cost the same as it would under the ACA. And they must prove that their plan will not increase the federal deficit.

A few states appear to be pursuing waivers, Harders said. She said those states include Vermont, which is considering scrapping its exchange in favor of a single-payer system, and Arkansas, which is planning to get private insurers involved in its Medicaid program. In addition, California is seeking to allow undocumented immigrants to apply for health insurance under its state exchange.

“For health insurers, I think they should keep an eye on how these work out because there could be an opportunity for them to launch new products in states where waivers are granted,” she said.

States could apply for waivers that would allow them to expand premium subsidies, or to increase consumer choices and insurance competition in the marketplaces.

Prior to submitting an application for a waiver to HHS, a state must provide public notice and hearings on the proposal. After that, HHS and the Treasury Department will review the application and hold a public notice and comment period.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].