The 1332 State Innovation Waiver
Beginning January 1, 2017, states may apply for a component of ACA legislation termed the Section 1332 State Innovation Waiver. This waiver permits states to modify elements of the ACA in exchange for alternative state health care legislation. The intent of the waiver is to allow states to pursue creative health reform strategies while retaining the basic provisions of the ACA. State policymakers can use the waiver to advance a health care reform agenda that improves access to quality, affordable health insurance while allowing a state to account for its distinct needs and environment.
The 1332 Waiver allows states to create alternatives to the following ACA provisions: 1. The individual mandate to carry health coverage 2. The employer mandate to offer coverage 3. The premium and cost-‐sharing subsidies available in the exchange 4. The health benefit exchanges and essential health benefits requirement
However, there are fundamental provisions of the ACA that states cannot waive. These include the “stand-‐alone” components such as guaranteed issue, annual and lifetime coverage limitations, increased coverage of preventative care, and the requirement to allow dependents up to the age of 26 to be enrolled into their parent/guardians insurance plan.
Furthermore, any proposed reform must also follow four guiding principles regarding expected outcomes. Essentially these guardrails stipulate that any reforms must improve upon the ACA, not weaken its achievements. These four guardrails are:
1. Maintenance of the current level of coverage/enrollment 2. Maintenance of the current level of affordability 3. Maintenance of the current level of comprehensiveness of benefits 4. Maintenance of deficit neutrality (no added cost to the federal government)
158