Last week, we highlighted the recent announcement made by the CMS Administrator on new guidelines for section 1332 waivers under the ACA. Waivers under section 1332 allow states to make changes to the way the marketplace operates within their state and CMS says the new guidelines will provide states greater flexibility. In the new issue brief entitled “New Rules for Section 1332 Waivers: Changes and Implications“, the Kaiser Family Foundation explain that 1332 waivers have been largely used so far to allow states to accomplish reinsurance plans for their markets.
The new guidance would expand the possible uses for which states could use 1332 waivers, including possible subsidies for plans that are not compliant with the ACA’s consumer protections. The issue brief does point out that this could potentially divide the market where those people with pre-existing conditions would only be able to find coverage on the ACA marketplace where healthier consumers could buy “off-market” with subsidies under the 1332 waivers. This could destabilize the ACA marketplace creating a de facto high risk pool. To learn how the guidance is different from prior policy under the Obama Administration, the brief also provides a comparison chart between Obama Administration guidance in 2015 and Trump Administration guidance in 2018.
