California has made great progress implementing the Affordable Care Act (ACA), with almost 4.7 million people newly enrolled in either Medi-Cal or Covered California since January 2014. The state now strives to improve the quality of care and the performance of its safety net delivery systems as it moves toward renewal of its §1115 Medicaid waiver. Beginning in 2017, the ACA offers another major opportunity for states to meet these goals with a §1332 waiver. These broad waivers would allow states the ability to waive several requirements of the ACA to create new and innovative models to improve and expand health coverage.
To create and finance a new coverage framework, a §1332 waiver would allow states to waive four major planks of the ACA:
- The individual mandate to have health coverage
- The employer mandate to offer coverage
- The health benefit exchanges and the essential health benefits requirement
- The premium and cost-sharing subsidies available through the Exchanges.
Nevertheless, the ACA requires that states’ §1332 programs would have to exceed or be comparable to the law’s standard coverage framework in the following four ways:
- The number of people covered
- The scope of health benefits
- Consumer affordability
- Containing the cost to the federal government