- This week, Vermont legislators filed an ACA state waiver (Section 1332).
- The waiver requests permission for the state to, in lieu of creating a small business insurance exchange website, grant employers the ability to directly enroll in health plans, American Health Line's First Look reports.
- The move could serve as a proof-of-concept for states exploring similar options.
As Hawaii released a draft waiver proposal late last year and Kentucky Gov. Matt Bevin (R) attempts to maybe kinda sorta follow through on his promise to dismantle Medicaid expansion in his state, Vermont could serve as model for how the Section 1332 waiver works in practice.
As noted, Vermont's earlier attempt to create a single-payer system via a waiver fell through because the project was too costly. Because of that failure, and a lack of guidance as to what can be proposed via the waiver, expectations for what states will do with this potential opportunity had declined.
Late last year, HHS published waiver guidance in the Federal Register. As Modern Healthcare noted, "HHS also stressed that it will approve the waivers only if they do not increase the federal deficit."
States may apply to the HHS and the Treasury for waivers from various provisions of the ACA starting Jan. 1, 2017. Waiver proposals must be authorized by the state's legislature and developed through a public process and can be approved for up to five years.