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Eye On Boise

‘State innovation waivers’ bypass some ACA requirements for coverage plans, don’t apply to Medicaid

Lawmakers on the Idaho Legislature’s health coverage working group are hearing about “innovation waivers” this morning, in a presentation from the National Conference of State Legislatures; these are not the waivers that deal with Medicaid expansion. Instead, these are federal waiver programs that allow innovative state programs providing health coverage, outside of Medicaid, to waive certain requirements of the national Affordable Care Act, including some provisions of the individual and employer mandates. However, they still must provide comprehensive coverage, to the same number of individuals, and be at least as affordable. They are new, and will start Jan. 1, 2017.

An example is a state using a Section 1332 waiver to offer higher tax subsidies to make coverage more affordable. Hawaii, Massachusetts and Vermont have applied for such waivers to continue state policies they already had in place regarding health coverage, with “relatively modest and limited content,” said Dick Cauchi of NCSL, “mostly relating to small businesses.” California has applied for one to cover undocumented immigrants with unsubsidized health plans.

"That may include increased responsibility by the state," Cauchi said.

Ten states have passed laws seeking to use this type of waiver, for varying reasons, Cauchi said. Washington had a bill pass its Senate, but not House, seeking to use a 1332 innovation waiver to expand an employer-based coverage option with a portable health account.

Idaho officials have been discussing applying for a different type of federal waiver, most likely a Section 1115 waiver, to tap federal Medicaid expansion funds but use them for a redesigned coverage program for its 78,000 residents who currently fall into a coverage gap, rather than expanding the more traditional Medicaid program.

Cauchi also noted a statistic that makes Idaho look good: “It looks to me that Idaho is one of only two states that appears … to have more insurers in 2017 than in 2016,” he said. “This is maybe a coincidence of statistics.” Noting that things can change, he said, “I’m not throwing some great meaning into it. ... I don’t  want to say you are one of the two leading states that have increases in coverage, but that’s what a statistic shows.”

Sen. Marv Hagedorn, R-Meridian, co-chair of the legislative panel, said, “Interesting. Thank you.”

Betsy Z. Russell
Betsy Z. Russell joined The Spokesman-Review in 1991. She currently is a reporter in the Boise Bureau covering Idaho state government and politics, and other news from Idaho's state capital.

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