A Permanent Boost to Federal Premium Assistance Could Change State Approaches to ACA 1332 Waivers

The temporary enhancements to marketplace premium subsidies provided by the American Rescue Plan are lowering premiums for millions of Americans, will likely reduce the number of uninsured by 1.3 million in 2022, and could produce larger and longer-lasting coverage gains if made permanent. A permanently more generous federal premium assistance program would benefit enrollees directly while also giving states more latitude to address other barriers to their residents’ care.

One way states could capitalize on such an opportunity is by reconsidering the ACA’s Section 1332 waiver program. While to date, waivers have been used mostly to facilitate state-run reinsurance programs — with demonstrable success — permanent improvements to premium affordability could call for different policy approaches and may expand the uses to which a waiver might be put. Going forward, states may find greater value in waivers that support programs addressing health care system costs or that reduce the burdens of high enrollee cost sharing.

To read more, you can access the full analysis at The Commonwealth Fund.

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