- CMS issued a request for information on new ways states can use the Affordable Care Act's Section 1332 waivers, which the Trump administration has rebranded as "relief and empowerment" waivers, to get around key components of the law.
- The agency is asking industry stakeholders for ideas on programs and concepts that could be tested in their insurance markets in order to build a database of different waiver options, according to documents posted Wednesday.
- CMS left the RFI broad, but included potential options. These include waivers that could be enacted along with other waivers, policies or laws; waivers building off 2018 guidance; and waivers including all waivable requirements possible under Section 1332. Comments are due July 2.
The move comes as the administration continues efforts to sidestep requirements of the ACA, alongside a legal battle to do away with the landmark law entirely.
The ACA always included provisions for states to experiment with various models, but the Trump administration has strongly encouraged states to pursue more conservative policies like Medicaid work requirements.
A federal judge declared the ACA unconstitutional in December, and in a largely unprecedented move, the U.S. Department of Justice declined to support the legislation, which insures millions of Americans. The decision was stayed, and arguments in appeals court are expected in July.
The courts aren't the only arena where the ACA is under attack. The Trump administration has cut the open enrollment period for coverage in the federal exchanges in half for the past two years, slashed advertising for the ACA marketplace and cut the number of navigators who help consumers find plans.
Enrollment for 2019 coverage in the federal exchanges dropped roughly 4% from the previous year, largely as a result of such policies, experts say.
CMS Administrator Seema Verma said the waivers grant states needed flexibility to tailor their ACA exchanges to offer affordable coverage tailor-made for their residents. "As experience with the [ACA] shows, when Washington imposes a one-size-fits all approach on every state, any problems with the approach become nationwide problems," she said in a blog post accompanying the RFI.
According to the post, CMS wants to create a "library of options" states can choose between if they're interested in implementing a waiver or want to build off an existing model.
Last year, HHS announced waivers that allowed states to look for workarounds to certain ACA requirements. Originally intended as a way for states to explore individualized ways to bolster ACA performance, Medicaid Section 1332 waivers, or "state innovation waivers," were rebranded as "state relief and empowerment waivers" under the Trump administration.
CMS opened up additional flexibility for the waivers in October to a wave of criticism. The guidance encouraged states to leverage association and short-term limited duration health plans, cheap coverage that doesn't have to cover preexisting conditions or meet the ACA's 10 essential health benefits.
A month later, CMS offered four additional waiver concepts: account-based subsidies, state-specific premium assistance, adjusted plan options and risk stabilization strategies. The waiver type expansion also landed in hot water amid allegations they would flood the markets with so-called "junk plans" and increase costs for low-income Americans.