What They’re Thinking: Stopgap, guardrails and the ‘spirit of the waiver’
A. The reason behind the waiver is because
They actually refer to it as emergency regulatory relief to underscore that.
The 1332 waiver is a provision of the Affordable Care Act. Effectively what that provision is designed to do is to say, under the federal system of government, we will give states option of doing things their own way provided they still meet objectives of ACA.
Those are offering coverage that is comprehensive, affordable and covers as many people as the ACA would and to not increase the federal deficit.
What
The subsidy money that would come to the state to help them run this program would still be given out as tax credits, but they would be expanded to go above 400 percent of the poverty level.
This is more generous than the ACA, ... but it could make insurance more expensive for lower income individuals than what they'd pay under the ACA. Q. Some have said the waiver is asking to do a lot more than that. What do you think?
A. That's the whole idea of guardrails -- the spirit of the waiver. If states can accomplish what the ACA can accomplish and come up with their own way to do it that they like better, then they should be allowed to do that.
The government put those guardrails in place so that states couldn't propose to do things that undermine the ACA and what it's supposed to do.
The
Essential health benefits, that seems fine, they've met that as far as I can tell.
That said, you could play it backward and say if you compare that coverage with the ACA that has no plans in the marketplace and the coverage is zero. You can argue it either way ...
There haven't been too many state to go this route --
You might see a lot of other states, especially conservative ones, do things they've been wanting to do and feel this gives them broad leeway to redesign things and not comply with the ACA.
Q. So if the stopgap is approved, do you think it could undermine the ACA?
A. That's the big worry. If you can meet the objectives of the ACA, but in a different way -- think about it like driving directions: You open your GPS and it gives you three different routes. If you can take any of those and end up in the same place by different means, that's OK.
But you take the guardrails out of the equation, then you're not ending up in the same place and you're ending up in a different location than intended.
So with health care, you're not covering as many people, or the benefits are not as good or as coverage is not as affordable.
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