States Receive Guidance on Health-Reform Waivers
Abstract
In March the departments of Health and Human Services (HHS) and Education issued a proposed rule for states applying for waivers from provisions of the Affordable Care Act (ACA). In addition, President Obama has announced his support for bipartisan legislation that would move the timeline for availability of state waivers from 2017 to 2014.
In January's State of the Union Address, the president stressed that he was open to new ideas for improving the health care reform law. Echoing this commitment, HHS Secretary Kathleen Sebelius stated in a press release announcing the new rule that "Innovation Waivers empower states to take the lead on implementing the Affordable Care Act."
The waivers are designed to give states the latitude to implement their own health care policies, which may differ from those in the ACA as long as they meet specified criteria. The press release lays out the criteria contained in the proposed rule, requiring states to provide coverage that meet these requirements:
It must be at least as comprehensive as that offered through health insurance exchanges—new competitive, private health insurance marketplaces.
It must be at least as affordable as the cost-sharing protect ions through the exchanges.
It must provide coverage to at least as many residents as otherwise would have been covered under the Affordable Care Act.
It must not increase the federal deficit.
An HHS fact sheet on the proposed rule notes that states receiving waivers would also be required to submit quarterly and annual reports tracking measures in the four areas listed above and that the regulations suggest areas for continued monitoring of the waivers, such as choice of health plans and coverage of individuals with preexisting conditions.
The president has thrown his support behind a bipartisan bill to move the start date for implementation of state waivers from 2017 to 2014. The start date is important because many of the provisions of the ACA do not go into effect until 2014. If states can receive wavers at that time, they can continue with any innovations they already have in the works without stopping to switch to implementing the federal requirements.
Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) first introduced the Empowering States to Innovate Act last November. In a press release Wyden stated that "some of the most innovative approaches to health policy have originated at the local level, where lawmakers have a unique insight into their constituents' lives, and the state waiver simply gives states the bandwidth to pursue those kinds of approaches." Brown said that "states shouldn't be forced by the federal government to adopt a one-size-fits-all health care plan."
Julie Clements, deputy director for regulatory affairs in APA's Department of Government Relations, stated that "we support the secretary's requirement that any innovative state programs substituting for Affordable Care Act provisions must still satisfy the ACA's goals of coverage, cost-sharing, and comprehensive benefits. These requirements preclude the waiver program from being a means to circumvent the goals of ACA regarding coverage, cost-sharing, and comprehensiveness." APA will likely submit brief comments to the Centers for Medicare and Medicaid Services reiterating support for the goals of ACA and the hope that states that "do innovate will go above and beyond the more positive aspects of the ACA and how it treats mental health."
The comment period on the proposed rule is open until May 13.
The proposed rule is listed in theFederal Register at <http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2011_register&docid=fr14mr11-23.pdf>. The Empowering States to Innovate Act is posted at <http://thomas.loc.gov/cgi-bin/query/z?c112:H.R.844:>.
