Lawmakers debate how much wiggle room to give states in health care

September 7, 2017

Lawmakers debate how much wiggle room to give states in health care

Kaiser Health News

One of the few things that Republicans and Democrats broadly agree on is that states should have some flexibility to experiment with different ways to pay for and deliver health care.

But they disagree — strongly — on how much. In fact, Republicans don’t agree with one another on this, and that dissent helped sink efforts this summer to “repeal and replace” the Affordable Care Act. Bridging these divides will help determine the success of a bipartisan effort in the Senate this month to help shore up the individual health insurance market.

“I’ve always said not all the wisdom is going to be in Washington,” said Sen. Ron Wyden (D-Ore.), the ranking Democrat on the powerful Finance Committee. “Progressive and conservative folks are going to say ‘we can do better.’”

The federal health law includes a provision that allows states to alter some of its rules if they can think of a better way to provide health care to their residents. These are known as “Section 1332 waivers,” bookmarking where they are located in the health law.

But the law strictly limits how far states can go with their experiments. It includes what are known as “guardrails.” Those limits, said IHPI member Nicholas Bagley, a health law professor at U-M, “are to prevent states from undermining the Affordable Care Act goal to provide people with comprehensive coverage.”

The waivers were designed “so blue states can experiment with blue state solutions, and red states can experiment with red state solutions,” said Bagley. “But to do so and stay within the guardrails is really difficult.” For example, he said, “you can reallocate the money, but you can’t reallocate it to create losers.”

At issue is whether to broaden authority for states by revising or eliminating the “guardrails” intended to protect patients and the federal government.

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