1. 2017 Georgia Legislative Policy Forum
Empowering States for Better Healthcare
Rea S. Hederman Jr.
Executive Vice President

2. The 4 Guardrails of State Innovation Waivers
1) A state must demonstrate that “at least a comparable number of residents” would have health coverage under its plan as under existing law.
2) That coverage must be “at least as comprehensive” as under the law.
3) Coverage must be “at least as affordable” as under that law.
4) A state must achieve these objectives without increasing the federal deficit.

3. What Can and Cannot be Waived
Provisions the Secretary MAY waive
Provisions the Secretary MAY NOT waive
Definition of qualified health plan.
Prohibition on annual/lifetime coverage limits
Essential health benefits requirement
Prohibition of rescissions
Annual limitation on cost-sharing
Required coverage of preventive services
Levels of coverage (e.g., Silver, Bronze)
Dependent coverage until age 26
Abortion coverage limitations
Medical loss ratio requirements
Open enrollment periods
Prohibition of pre-existing condition exclusions
Single risk pools
Guaranteed issue and renewal of coverage
Federal regulations pertaining to enrollment by agents/brokers
Prohibition of medical underwriting
Exclusion from exchanges of incarcerated persons and those not lawfully present in the U.S.
3:1 age band
Table 1. Examples of ACA Provisions the HHS Secretary May/May Not Waive
Provisions the Secretary MAY waive
Provisions the Secretary MAY NOT waive
Definition of qualified health plan.
Prohibition on annual/lifetime coverage limits
Essential health benefits requirement
Prohibition of rescissions
Annual limitation on cost-sharing
Required coverage of preventive services
Levels of coverage (e.g., Silver, Bronze)
Dependent coverage until age 26
Abortion coverage limitations
Medical loss ratio requirements
Open enrollment periods
Prohibition of pre-existing condition exclusions
Single risk pools
Guaranteed issue and renewal of coverage
Federal regulations pertaining to enrollment by agents/brokers
Prohibition of medical underwriting
Exclusion from exchanges of incarcerated persons and those not lawfully present in the U.S.
3:1 age band

4. Current 1332 Waivers Vermont Single Payer (Withdrawn)
Hawaii Exchange (Approved)
Alaska Reinsurance Waiver (Approved)
Minnesota Reinsurance Waiver (Approved)
Other States Asking for Reinsurance
Iowa, Oklahoma (withdrawn), Oregon, Massachusetts
Vermont Single Payer (Withdrawn) Hawaii Exchange (Approved) Alaska Reinsurance Waiver (Approved) Minnesota Reinsurance Waiver (Approved) Other States Asking for Reinsurance Iowa, Oklahoma (withdrawn), Oregon, Massachusetts

5. Thinking Big on State Innovation Waivers
Oklahoma
Move to a more market based approach.
Flat Premium Subsidy based only on age/income
Expand Health Savings Accounts
Use $ from federal government to help 0-300% FPL
Use some state $ for reinsurance/subsidies
Change Benefits and only 1 metal tier

6. Thinking Big on State Innovation Waivers
2) Iowa
Flat Premium Subsidy based only on age/income.
Only use $ From federal government to provide subsidy.
All Consumers on exchange market get subsidy, even over 400% of FPL.
Only 1 metal tier (likely silver plan).

7. “CMS previously displayed its ability to be flexible in its adherence to the provisions of the ACA in its continued extensions of the transitional relief program requested by former President Barack Obama as related to grandmothered plans. CMS created a ‘transitional policy’ allowing for health insurance carriers to continue to offer certain non-compliant ACA policies to existing consumers. This continued policy position demonstrates that CMS does have authority to be accommodating and adaptable in its interpretation and implementation of the ACA.” Iowa 1332 Waiver