On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (the ARP), a wide-ranging package of health care and economic measures responding to the coronavirus pandemic. The ARP includes a broad expansion of the Affordable Care Act’s (ACA) main health insurance subsidy, the premium tax credit (PTC), the first major expansion of the health care reform law since its passage. This piece highlights the policymaking considerations that states must account for in light of the PTC expansion and uncertainty about future federal action. A key theme that emerges is that states will benefit from approaches that give them the flexibility to adjust policies year by year as the federal landscape develops.
1332 State Innovation Waivers: What’s Next for States
Manatt Health Solutions
Waivers available under Section 1332 of the Affordable Care Act offer potentially great flexibility to states in achieving the goals of the ACA through very different means than originally envisioned. They take effect as early as January 1, 2017, and require legislative authorization, substantial public engagement, and negotiation with the federal government. Moreover, without grant dollars to fund the development process, unlike for the establishment of state-based exchanges, 1332 waiver proposals will present additional time and resource challenges for states.
For states interested in rolling out new waiver-based reforms in early 2017, now is the time to begin thinking through possible ideas. The initial call of the State Network 1332 Waivers Affinity Group included a presentation from Manatt Health Solutions on the potential and limitations of these waivers. This slide deck, presented by the team at Manatt, provides an overview of the basics of the waivers, including information on what can and cannot be waived and statutory guardrails, the process for obtaining a waiver, and possible opportunities for state innovation.