Opting Out of Reform: How is it done?

The purpose of this post is not to argue for or against opting out of The Patient Protection and Affordable Care Act. Although, that is probably the discussion it will invoke. Instead, the purpose of this post is to help the reader understand what exactly the State Waiver is and what is required in order for it to be granted.

Section 1332 of The Patient Protection and Affordable Care Act allows for Waiver of State Innovation. This Waiver allows for the Secretary of Health and Human Services and the Secretary of the Treasury, to waive certain requirements falling under the jurisdiction of the State for plan years beginning on January 1, 2017. The waiveable requirements include but are not limited to: establishment of qualified health plans, consumer choices and insurance competition through health benefit exchanges, reduced cost sharing for individuals enrolling in qualified health plans, refundable credits for coverage under a qualified health plan, shared responsibility for employers regarding health coverage, and the requirement to maintain minimum essential coverage.

The purpose of the Waiver of State Innovation is to allow States flexibility in their options for providing accessible, affordable comprehensive health care to their residents. In order to qualify for a Waiver, the State must cover the same number of residents that would otherwise be covered under the Act at a similar or lower cost. In addition, the consumer protections available under Act, such as insurance denials, caps, and limits on care must be maintained.

The proposed regulations were issued by the Secretary of Health and Human Services on March 10. See  http://www.ofr.gov/OFRUpload/OFRData/2011-05583_PI.pdf They include requirements for the information required to submit the Waiver application, the public’s access to that information, and the monitoring required.

The Waivers are slated to go into effect in 2017. However, President Obama has stated that he would support moving that date forward to 2014, when the State Health Exchanges are set to begin.

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