New Policies Empower States and Deliver Flexibility to Make Health Insurance More Affordable and More Accessible for Millions of Unsubsidized Americans
December 6, 2018 - Last week, Centers for Medicare & Medicaid Services’ (CMS) Administrator Seema Verma—in an address to the States and Nation Policy Summit of the American Legislative Exchange Council (ALEC) in Washington, D.C.—shared her vision for innovations and reforms that will empower states and provide the flexibility states need to create alternatives to the Affordable Care Act (ACA) that improve health insurance options.
Speaking to hundreds of state legislators, local government leaders, administration officials and stakeholders in a keynote address, Verma emphasized the need for states to retain a strong, lead role in addressing the toughest issues facing this country and, in particular, health care. As she explained, “Seeing the problems the ACA created and seeing the lack of federal action to address these problems should be proof enough for why it was such a mistake to federalize so much of health care policy under the ACA.”
To encourage states to reclaim a more active role, Verma announced the release of four waiver concepts designed to illustrate how states can waive certain ACA provisions under section 1332 of the law and develop alternatives to the ACA’s otherwise one-size-fits-all approach. These waiver concepts build on the recently issued guidance on section 1332 waivers, now known as State Relief and Empowerment Waivers. Under this new guidance, states are empowered to innovate new health care programs aimed at reaching important goals, including strengthening their health insurance markets, expanding choices of coverage, and targeting public resources to those most in need.
The concept with perhaps the best potential to address various structural problems with the ACA would create a new account-based program to help subsidize health care expenses. The account-based approach would allow a state to provide a cash contribution to an account that people can use to pay both premiums and any out-of-pocket health expenses. This approach maximizes consumer choice and engagement, giving people flexibility to make smarter decisions with their health care dollars because they directly retain the benefit of any unspent funds from the account. The account provides the opportunity to create true portability and continuity across the Exchange, Medicaid, and employer-sponsored coverage. This flexibility also helps to control premium growth and limit the growth in public subsidies by establishing a clear individual health care budget up front.
In addition to the account-based approach, Verma also unveiled three additional waivers to illustrate how states can take advantage of the new flexibilities through a State Relief and Empowerment Waivers:
- States can develop a new premium subsidy structure and decide how those premium subsidies should be targeted;
- States can set the rules for what type of health plan is eligible for state premium subsidies to give people access to more health plan options; and
- States can implement risk stabilization strategies to address the costs of high risk individuals to reduce premiums in the market for everyone.
CMS developed the waiver concepts to help states understand the potential waiver options and how the recent guidance might be used. Using the waiver concepts, states can restructure some of the most restrictive ACA requirements to craft their own solutions. States that opt to utilize waiver concepts can choose to use them alone, in conjunction with each other, and in combination with other innovative state proposals.
Verma concluded with her vision for CMS working in partnership with states: “Today, we are saying the states have the power to make the individual markets work through innovative policies that best meet the needs of your citizens. We are returning freedom, authority and innovation to you, state lawmakers. And I believe the results will be better, and more Americans will be insured because of it.
For more information, please see the fact sheet here: https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Downloads/Waiver-Concepts-Fact-Sheet.pdf