States Could Change Obamacare

States may soon get more leeway to make changes to Obamacare that could affect the comprehensiveness of coverage.

“We are expecting a new enforcement rule out soon,” Joel White, president of the Council for Affordable Health Coverage, said at a recent Capitol Hill briefing I covered.

Section 1332 of the Affordable Care Act enables states to ask for permission from the Department of Health and Human Services to make changes to the ACA, including changes to requirements on health plans and the ACA marketplaces, as well as changes to the ACA-mandated essential health benefits coverage and to the financial assistance system.

But there are “guardrails” on those major changes written into the law, requiring that coverage be as least as comprehensive and affordable as it would be without waivers, a comparable number of residents are covered, and the waiver doesn’t increase the federal deficit.

Many states have complained that the Obama administration implemented the provision too rigidly, preventing states from taking steps to make plans more affordable for people who make too much money to qualify for subsidies under the ACA.

About 87 percent of people enrolled in marketplace plans receive subsidies, but from 2016 to 2017, the number of people who didn’t receive subsidies dropped 20 percent in the ACA-compliant individual market, according to a recent HHS report.

For example, many people in the individual market in Wisconsin are farmers who used to purchase health insurance policies that included work-related injuries before the ACA rules took effect, Wisconsin Deputy Commissioner of Insurance J.P. Wieske said. Wisconsin would like to add benefits to its individual plans to make them more useful to farmers, he said.

Wisconsin is also looking for more flexibility to promote the use of association health plans, Wieske said. The Trump administration recently issued final rules that make it easier to offer association health plans, which may not comply with all ACA requirements.

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