Verma Shares Vision for More State “Flexibility” in Affordable Care Act

November 30, 2018 - CMS has released new policies that purport to help states create “alternatives” to the Affordable Care Act (ACA) and improve health insurance options, according to CMS Administrator Seema Verma.

In an address to the States and Nation Policy Summit of the American Legislative Exchange Council (ALEC) in Washington, DC, Verma emphasized the need for states to address the toughest issues facing the country, particularly in healthcare.

“Seeing the problems the ACA created and seeing the lack of federal action to address these problems should be proof enough for why it was such a mistake to federalize so much of health care policy under the ACA,” she said.

Verma announced the release of four new waiver concepts designed to help states circumvent certain ACA provisions under section 1332 of the law. These waiver concepts build on recently issued guidance on section 1332 waivers, now known as State Relief and Empowerment Waivers.

This new guidance allows states to create new health programs and reach important goals, including strengthening their health insurance markets, expanding coverage choices, and targeting public resources to those most in need.

In her address, Verma revealed a new policy to create an account-based program that would help subsidize healthcare expenses. The account-based approach would allow a state to provide a cash contribution to an account that people can use to pay both premiums and any out-of-state health expenses. This approach allows people to directly retain the benefit of any unspent funds from the account.

The account offers the opportunity to facilitate continuity across Exchange, Medicaid, and employer-sponsored coverage, CMS said. This flexibility will also establish a clear individual healthcare budget up front, which the agency believes will help to control premium growth and the growth of public subsidies.

In addition to this account-based approach, Verma discussed how states can develop a new premium subsidy structure and decide how those subsidies should be targeted. She also unveiled a policy that says states can decide what type of health plan is eligible for state premium subsidies.

Verma detailed a fourth concept, which instructs states to implement risk stabilization strategies. These strategies will help to address costs of high-risk individuals and reduce premiums in the market.

States that do choose to utilize the waiver options can use them alone, in collaboration with other states, and in addition to other innovative state proposals.

With the announcement of these new concepts, CMS will help states improve the health insurance access and affordability.

“Today, we are saying the states have the power to make the individual markets work through innovative policies that best meet the needs of your citizens. We are returning freedom, authority and innovation to you, state lawmakers. And I believe the results will be better, and more Americans will be insured because of it,” Verma concluded.