States are just beginning to seriously explore the potential of 1332 waivers. The limited engagement to date reflects both the highly partisan nature of the debate around the ACA and uncertainty about the future and scope of funding sources that currently flow through the ACA exchanges. Congress and the Trump Administration should address both issues simultaneously.
Congress should enact waiver legislation that clarifies the availability of federal subsidies for the purposes of evaluating waivers' deficit neutrality, including all potential federal spending that could be offset by a waiver, and evaluates its impact over a long (8-10 year) time period after an initial pilot period. Federal “guardrails” to prevent unintended consequences on patient outcomes and the deficit should focus on collecting data on costs and impact on vulnerable populations, while expanding consumer choices around affordable, high quality plan options.
Read Full Article »