States Innovation Waivers under the ACA: A Closer Look at the Updated Federal Guidance and State Proposals

By Kevin Lucia, Justin Giovannelli, Sean Miskell and Ashley Williams

The Affordable Care Act (ACA) established a framework—including now-familiar elements like insurance marketplaces and premium tax credits—to expand access to affordable, comprehensive health insurance coverage. However, the law also gives states a chance to realize these goals using alternative solutions. Starting in 2017, states can pursue “innovation waivers,” sometimes known as 1332 waivers, that allow them to modify key parts of the ACA. These waivers may propose “broad alternatives or targeted fixes” to a number of the ACA’s private insurance provisions, so long as they stay true to the law’s goals and consumer protections. 

But there’s a critical catch. States can forge their own path only within certain limits set by the law itself: a waiver must ensure coverage is at least as comprehensive and affordable as the ACA, must cover a comparable number of residents, and can’t add to the federal deficit.

In a recent blog post for the Commonwealth Fund, CHIR researchers Kevin Lucia, Justin Giovannelli, Sean Miskell, and Ashley Williams take a closer look at the states that have submitted waiver applications, as well as those considering an innovation waiver for 2017. The authors provide an analysis of the requirements these state must meet, when applying for and preparing the waiver application. Read about their findings here.

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