- Section 1332 of the Affordable Care Act allows states to apply for a waiver from many of the law's requirements to pursue innovative strategies for healthcare reform.
- The waivers, which will be available in January 2017, are an opportunity for states to expand coverage or to change the way healthcare is currently being delivered.
- It's questionable whether states will take advantage of this opportunity.
Under the 1332 waiver, states can request almost anything they want -- including a repeal of the individual mandate -- if some tough conditions are met. To be granted a waiver, a state must propose an alternative that is at least as comprehensive and affordable, provides coverage to a comparable number of state residents and does not increase the federal deficit.
But less than 18 months before the implementation date, the most ambitious plan so far, to create a single-payer system in Vermont, has fallen 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 have declined.
"Vermont was trying something that was really expansive and ambitious," Heather Howard, director of the State Health Reform Assistance Network at Princeton University, told National Journal. "It doesn't have to be that whole scale of improvement."
The Department of Health and Human Services has said it will provide additional guidance, but has not said when that will occur.