Section 1332 of the ACA allows states to be innovative in their approach to health care reform by obtaining 1332 waivers from the federal government. States can propose unique, state-specific solutions – which can include fairly substantial changes in terms of how the ACA is implemented in the state – as long as consumer protections are maintained, people don’t lose coverage, and the federal government doesn’t have to spend any more than they would have without the state’s innovation.
In order to be approved, a state’s 1332 waiver proposal must ensure that :
- Residents will have access to coverage that is at least as comprehensive as it would be without the waiver
- Premiums and cost-sharing have to be at least as affordable as they would be without the waiver
- At least as many people have to be covered under the state’s new approach as would be covered without the waiver
- The state’s approach cannot result in increased federal spending
To apply for a 1332 waiver, a state has to submit their proposal to CMS, with detailed explanations of what ACA provisions they wish to waive, how the state-specific program will be implemented, the proposed budget, and how the program will meet the four basic guidelines described above.
CMS has a web page where you can see details about the states that have submitted 1332 waivers, and the status of those proposals. As of November 2017, waivers have been approved for Alaska, Hawaii, Minnesota, and Oregon. Several other states have submitted waivers — some have since withdrawn them, while others are still pending CMS approval.