Summary
Effective January 1, 2017, Section 1332 of the Affordable Care Act (ACA) permitted states to waive certain provisions of the law in order to pursue alternate strategies for providing access to health insurance in the individual and small group markets. However, potential changes to the Section 1332 waiver statute have been a central focus of the 2017 health reform debate, both in the Senate’s ACA repeal efforts, and as a bargaining chip in the bipartisan market stabilization deal stuck between Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) of the Senate Health, Education, Labor and Pensions (HELP) Committee.
As of October 2017, four states have successfully secured approval of Section 1332 waivers, and five have either withdrawn their applications or been denied. In this issue brief we examine the proposals and experiences of each of these states in the first year of 1332 waiver implementation, discuss the role of the Trump Administration, summarize the differing approaches to 1332 waiver reform proposed this year, and look ahead to what might come next in 2018.