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Section 1332 Waivers And The Future Of State Health Reform


December 5th, 2014

Editor’s note: This post is part of a series of several posts stemming from presentations given at “The Law of Medicare and Medicaid at Fifty,” a conference held at Yale Law School on November 6 and 7.

The Affordable Care Act (ACA) turbocharges state innovation through a number of provisions, such as the creation of the Center for Medicare & Medicaid Innovation, funding for states to establish customized insurance exchanges, and Medicaid reforms such as health homes and projects geared toward the dual eligible population. Yet another component of the law holds even more potential for broad reform. Buried in Section 1332 of the law is a sparkplug for innovation called the State Innovation Waivers program.

Also known as 2017 waivers or Wyden waivers, 1332s offer wide latitude to states for transforming their health insurance and health care delivery systems. According to the statute, states can request that the federal government waive basically every major coverage component of the ACA, including exchanges, benefit packages, and the individual and employer mandates. But the cornerstone of 1332 waivers is the financing. To fund their reforms, states can receive the aggregate amount of subsidies—including premium tax credits, cost-sharing reductions, and small business tax credits—that would have otherwise gone to the state’s residents. Depending on the size of the state, the annual payment from the federal government for alternate coverage reform could reach into the hundreds of millions or even billions of dollars.

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State-Based Marketplaces: Leveraging Year-One Lessons To Boost Year-Two Enrollment


August 27th, 2014

In three months, consumers will log onto their state’s health insurance marketplace to investigate their options and enroll in a plan. Already, states are hard at work prepping for the second year of open enrollment, which begins November 15. State marketplaces are expected to increase the number of enrollees this year and adopting lessons from 2013-2014 can help.

A User-Friendly Marketplace

First and foremost, states need a user-friendly marketplace that functions properly and allows consumers, brokers, insurers and navigators to seek and provide information that is timely and credible. States know this, but recently, interviews with 100 staff from five successful state-based marketplaces (SBMs) unearthed several less obvious lessons.

To begin, states should move from last year’s ‘shotgun’ marketing that helped build awareness to a more targeted approach to outreach this year. In addition to some mass marketing to maintain awareness, states should target advertising dollars to high-priority segments and focus on less expensive tools, like direct mailing campaigns and walk-up enrollment centers, which proved to be most effective last year.

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Medicaid Expansion: Time For A Closer Look


December 11th, 2012

Medicaid plays a critical role in protecting the health of our nation’s most vulnerable populations, but it leaves out many people, including poor childless adults. To insure more people and fill these gaps in the program, the Affordable Care Act (ACA) allows states to expand their Medicaid programs to cover all adults earning up to 138 percent of the federal poverty level and pays 100 percent of expansion costs during the first three years, decreasing to 90 percent by 2020. This expansion of the Medicaid program accounts for about 50 percent of the coverage gains made possible by the law.

The Supreme Court’s ruling on the law left to the states the decision of whether to pursue this expansion, and some states on both sides quickly declared their intentions. Most, however, have chosen to delay a decision. Politics has been an important consideration for many, but with the election behind us, it’s time for the states to give greater attention both to the complex fiscal implications and the impact on those potentially eligible for the program.

With this in mind, the State Health Reform Assistance Network, an initiative funded by the Robert Wood Johnson Foundation, developed an analytical tool to help state policymakers assess the many variables involved in the decision and calculate the long-term fiscal impact on their state. While each state’s health care system, fiscal condition and demographics vary, the most important elements to consider do not. The State Network’s goal is to provide a reliable tool to help state leaders identify and evaluate all of the data that make up those elements.

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