Congress has failed to pass a replacement of the Patient Protection and Affordable Care Act, and Obamacare’s collapse is inevitable. To protect their citizens, state lawmakers should take the lead in passing free-market health care reforms.
One of the best ways they can accomplish this is by applying for a Section 1115 waiver from the Department of Health and Human Services. If approved, these waivers give states greater flexibility in how they manage their Medicaid programs.
Although Section 1115 waivers have often been used in the past to expand coverage or benefits, states can also use them to implement consumer-friendly reforms to their Medicaid programs. Reform proposals that states can submit to the Centers for Medicare and Medicaid Services through 1115 waivers include work requirements for a state’s expanded Medicaid population, coverage time limits, incentives for enrollees to engage in healthy behavior, and the implementation of cost-sharing measures.
States can also request for waivers to improve their health care marketplaces through Section 1332 of the ACA. The HHS secretary will not approve a waiver if it results in a reduction in the number of people covered by ACA or makes coverage more expensive or less comprehensive, but states can apply for waivers that would allow them to escape some of Obamacare’s most burdensome provisions.
For instance, states can apply to end the individual and employer mandates and the premium tax credit or implement cost-sharing mechanisms, premiums or health savings accounts. States can also apply for a waiver allowing them to redefine which services are considered essential health benefits.
A governor can submit a Section 1332 waiver request to the HHS secretary only after the waiver has been authorized by his or her state legislature. States must engage in a transparent public process when requesting a waiver, including publicizing requests on state websites, holding hearings and collecting public comments.
Dozens of states have already submitted waivers to HHS to create market-oriented reforms. The most recent waiver approved by HHS was in Minnesota, which will now be allowed to use federal pass-through savings from decreased premium tax credit costs on a new state reinsurance program. The program will allow companies providing coverage for high-cost, high-risk policyholders to purchase reinsurance to offset some of the increased risk of these plans. This could take some of the pressure off the risk pool and help reduce premiums across the board.
States should also work to repeal existing state regulations that are obsolete or counterproductive, including mandated benefits, guaranteed-issue, community rating and certificate of need laws. Additionally, lawmakers can improve their state’s health care market by removing unnecessary licensing standards, ending overregulation of dental service organizations, and limiting expensive maintenance of certification requirements.
The Trump administration has called on state lawmakers to submit waivers and push for Medicaid and ACA reform in their states. Other states should not wait until their health care markets are on the verge of collapse before trying to take back control from the federal government. The time to act is now.