Monday, February 17, 2020
Hawai'i Free Press

Current Articles | Archives

Thursday, November 03, 2016
Hawaii First State to File ‘Complete’ Obamacare Waiver
By Selected News Articles @ 4:40 PM :: 3464 Views :: Health Care

heatherhoward_exhibit1

State Interest In 1332 Waivers Gaining Steam

by Heather Howard and Dan Meuse, Health Affairs Blog, November 2, 2016

As 2017 draws closer, state interest in Section 1332 Waivers (also called State Innovation Waivers) is heating up. This is not entirely unexpected given that January 1, 2017 is the first day that these waiver programs could take effect. It is heartening to see that states are looking to this opportunity to make the Affordable Care Act (ACA) work better in their states, especially in the face of what many (including us) see as unduly restrictive guidance issued by the administration.

New 1332 Developments

In just the past few weeks, there have been interesting new developments on the 1332 waiver front.

Hawaii

Hawaii’s 1332 waiver to align its Hawaii Prepaid Health Care Act with the ACA has been deemed complete. The waiver will allow Hawaii to continue to administer its program that provides comprehensive coverage to nearly every full-time and many part-time employees in Hawaii. The completion notice from HHS means that Hawaii’s waiver will move to the analysis and approval process.

California

Covered California, the state’s health insurance marketplace, submitted its waiver to allow undocumented persons to purchase coverage on the marketplace. These purchases would not be eligible for tax credits or cost-sharing subsidies. The waiver application will now go through a completeness review by the federal government.

Alaska

Alaska recently passed a state-funded reinsurance plan for its individual market. Over the summer, guidance from the Center for Consumer Information and Insurance Oversight (CCIIO) encouraged states that invested in the stability of their state health insurance market to seek federal support through Section 1332 waivers. Alaska is signaling its intent to submit a waiver to further stabilize rising premiums and bolster its individual market.

What do these all have in common? These states are looking to use Section 1332 waiver flexibility to tailor solutions that meet the needs of their health care system. Each of these innovative solutions is unique to the state’s health care market, but together, they provide lessons for the future of state-based efforts to adapt the ACA’s coverage provisions according to state needs.

We have previously written about the opportunities (and limits) of Section 1332 waivers, and are not surprised that these three examples are targeted waivers designed to fit the narrow guidelines issued earlier this year by the Obama Administration. In each of these cases, the state is forging forward on state-specific decisions that thread the needle on acceptable waivers.

In Hawaii, the wavier protects its highly successful, pre-ACA (indeed pre-ERISA) employer mandate program, known as “Prepaid.” The state is seeking to waive some provisions that could cause either consumer or insurer confusion, but the waiver is not forecasted to change the affordability or comprehensiveness of coverage, nor change the number of people enrolled. In California, as part of a broader immigrant inclusion effort, which includes outreach efforts and coverage expansions, Covered California seeks to allow anyone, regardless of immigration status, to purchase unsubsidized coverage on the marketplace. The premiums and comprehensiveness of the plans for sale would not change. And while the details of Alaska’s wavier program are not available, one potential path based on the CCIIO guidance would be to leverage the savings in advanced premium tax credits from the lower premiums engendered by Alaska’s reinsurance plan, which will help stabilize the individual market. These savings could then be reinvested into the reinsurance program to increase its scope or longevity, and thereby continue or even enhance the program’s beneficial impact on rates.

States To Watch

But this is not the end of the story for 1332 waivers. Even though the path to system-wide reforms may be daunting, especially in the face of existing guidance, we continue to see states thinking about broader use of a 1332 waiver, and expect that the next Administration will consider broadening state flexibility. Two states bear watching:

Minnesota’s Health Care Financing Task Force reported on potential strategies to increase access and improve the quality of health care for Minnesotans, including the use of 1332 waivers. Legislationhas been introduced that would authorize the state to pursue a public option under a 1332 waiver. Such an effort could build on the state’s successful Basic Health Program (BHP), one of two in the country. To create their BHP, the state transitioned their pre-ACA MinnesotaCare program into a high actuarial value, low cost sharing coverage option for those up to 200 percent of the federal poverty level. The public option legislation envisions allowing Minnesotans of any income level to buy into that plan through the state’s marketplace, MNsure.

Oklahoma’s 1332 State Innovation Waiver Task Force has begun meetings to explore potential state-based ways to reduce the financial burden for residents and employers seeking affordable, quality health care coverage. Created after the state legislature earlier this year authorized the state to apply for a 1332 waiver, the task force includes a range of stakeholders, including businesses, consumer advocates, health care providers, and commercial health care insurers. The task force is charged with investigating a potential “alternative pathway for affordable, high quality health care coverage in Oklahoma’s commercial insurance market that meets the needs of Oklahomans.” While the task force is just starting its work, the conversations in Oklahoma will be interesting to watch given the state’s strong political opposition to the ACA.

Minnesota and Oklahoma are interesting states to watch because of their very different approaches to the ACA: the former has embraced the ACA, expanding Medicaid and setting up a state-based marketplace, while the latter has done neither. What they have in common, though, is their desire to pursue state-based solutions to the coverage and affordability challenges in their states. Section 1332 waivers, depending on their treatment in the next administration, can provide an important tool for state efforts.

Copyright ©2016 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc. Reprinted with Permission

Links

TEXT "follow HawaiiFreePress" to 40404

Register to Vote

2aHawaii

808 Silent Majority

808 State Update AM940

ABCDEFG Blog

ACA Signups Hawaii

ACCE

ALEC

Alliance Defending Freedom

Aloha Life Advocates

Aloha Pregnancy Care Center

American Council of Trustees and Alumni

American Mothers of Hawaii

AMVETS-Hawaii

AntiPlanner

Antonio Gramsci Reading List

A Place for Women in Waipio

Astronomy Hawaii

Audit The Rail

Ballotpedia Hawaii

Better Hawaii 

Blaisdell Memorial Project

Broken Trust 

Build More Hawaiian Homes Working Group

CAFR Hawaii

Castaway Conservative

Children's Alliance Hawaii

Children's Rights Institute

ChinaTownWatch.com

Christian Homeschoolers of Hawaii

Citizens for Recall

Cliff Slater's Second Opinion

Coffee Break

CSIS Pacific Forum

DAR Hawaii

DeedySupport.com

DVids Hawaii

E Hana Kakou Kelii Akina

E Māua Ola i Moku o Keawe

Farmers For Choice Hawaii

FIRE

Fix Oahu!

Follow the Money Hawaii

Frank in Hawaii

Front Page Magazine

Frontline: The Fixers

Genetic Literacy Project

Get Off Your Butts!

God, Freedom, America

Grassroot Institute

Habele.org

Hawaii Aganst Assisted Suicide

Hawaii Aquarium Fish Report

Hawaii Aviation Preservation Society

Hawaii Catholic TV

Hawaii Christian Coalition

Hawaii Cigar Association

Hawaii Coalition Against Legalized Gambling

Hawaii ConCon Info

Hawaii Credit Union Watch

Hawaii Crime Victims' Rights

Hawaii Crop Improvement Association

Hawaii Debt Clock

Hawaii Defending Marriage

Hawaii Defense Foundation

Hawaii Families for Educational Choice

Hawaii Family Advocates

Hawaii Family Forum

Hawaii Farmers and Ranchers United

Hawaii Farmer's Daughter

Hawaii Federalist Society

Hawaii Federation of Republican Women

Hawaii Firearm Community

Hawaii Fishermen's Alliance

Hawaii Future Project

Hawaii Gathering of Eagles

Hawaii History Blog

Hawaii Homeschool Association

Hawaii Jihadi Trial

Hawaii March for Life

Hawaii Meth Project

Hawaii's Partnership for Appropriate & Compassionate Care

Hawaii Public Charter School Network

Hawaii Rifle Association

Hawaii Right to Life -- Big Island

Hawaii Right to Life -- Oahu

Hawaii Shield Law Coalition

Hawaii Shippers Council

Hawaii Smokers Alliance

Hawaii State Data Lab

Hawaii Together

Heritage Foundation

HI Coalition Against Legalized Gambling

HIEC.Coop 

HiFiCo

Hiram Fong Papers

Homeschool Legal Defense Hawaii

Honolulu Homeless Crisis

Honolulu Navy League

Honolulu Traffic

Horns of Jericho Blog

House Minority Blog

House Republican Caucus YouTube

HPACC

Hump Day Report

I Vote Hawaii

If Hawaii News

Imua TMT

Inouye-Kwock, NYT 1992

Inside the Nature Conservancy

Inverse Condemnation

Investigative Project on Terrorism

Iowa Meets Maui

Jackson v Abercrombie

Jihad Watch

Judgepedia Hawaii

July 4 in Hawaii

Kahle v New Hope

Kakaako Cares

Kau TEA Party

Kauai Co GOP

Keep Hawaii's Heroes

KeyWiki

Land and Power in Hawaii

Legislative Committee Analysis Tool

Lessons in Firearm Education

Lingle Years

Malulani Foundation

Managed Care Matters -- Hawaii

Malama Pregnancy Center of Maui

Mauna Kea Recreational Users Group

MentalIllnessPolicy.org

Middle East Forum--The Legal Project

Mililani Conservatives for Change

Military Home Educators' Network Oahu

Missile Defense Advocacy

MIS Veterans Hawaii

Muslim Brotherhood in America

NAMI Hawaii

NARTH

Natatorium.org

National Christian Foundation Hawaii

National Parents Org Hawaii

National Wind Watch

New Zeal

NFIB Hawaii News

No GMO Means No Aloha

Northwest Economic Policy Seminar

Not Dead Yet, Hawaii

Now What I Really Think

NRA-ILA Hawaii

Oahu Alternative Transport

ObamaCare Abortion Hawaii

Obookiah

OHA Lies

Opt Out Today

OurFutureHawaii.com

Pacific Aviation Museum

Patients Rights Council Hawaii

PEACE Hawaii

People vs Machine

Pritchett Cartoons 

Pro-GMO Hawaii

P.U.E.O.

RailRipoff.com

Rental by Owner Awareness Assn

Republican Party -- Hawaii State

Research Institute for Hawaii USA

Rick Hamada Show

RJ Rummel

Robotics Organizing Committee

School Choice in Hawaii

SenatorFong.com

SIFE Remington

SIFE W. Oahu 

Sink the Jones Act

Smart About Marijuana--Hawaii

St Marianne Cope

State Budget Solutions Hawaii

State Policy Network

Statehood for Guam

Tax Foundation of Hawaii

The Harriet Tubman Agenda

The Long War Journal

The Real Hanabusa

Time Out Honolulu

Trustee Akina KWO Columns

Truth About Trade & Technology - Hawaii

UCC Truths

Union Members Know Your Rights

US Tax Foundation Hawaii Info

Valor in the Pacific

VAREP Honolulu

Waagey.org

West Maui Taxpayers Association

What Natalie Thinks

Whole Life Hawaii

Yes2TMT