There is a paradox in the power the Affordable Care Act lends to
states to devise alternative means to meet the law's goals. On the one
hand, the scope of the law's Section 1332 "innovation waivers" is sweeping:
states can propose alternatives to the law's coverage rules, funding and
subsidy formulas, and mechanisms for compelling participation, i.e.,
the employer and individual mandates.
On the other hand, the alternatives proposed in waiver applications must provide coverage "at least as comprehensive" as that defined by the ACA and protections against excessive out-of-pocket spending that render coverage at least as affordable as stipulated by the ACA. Waiver proposals must also cover "at least a comparable number" of the state's residents and must not increase the federal deficit.
Does the left hand's demand of equivalence take back the right hand's proffer of freedom of design? I posed the question to Nicholas Bagley, a health law scholar at the University of Michigan and former appellate attorney at the U.S. Department of Justice who blogs about health law and policy at The Incidental Economist.
On the other hand, the alternatives proposed in waiver applications must provide coverage "at least as comprehensive" as that defined by the ACA and protections against excessive out-of-pocket spending that render coverage at least as affordable as stipulated by the ACA. Waiver proposals must also cover "at least a comparable number" of the state's residents and must not increase the federal deficit.
Does the left hand's demand of equivalence take back the right hand's proffer of freedom of design? I posed the question to Nicholas Bagley, a health law scholar at the University of Michigan and former appellate attorney at the U.S. Department of Justice who blogs about health law and policy at The Incidental Economist.
