Repeal push complicates state efforts to get ObamaCare waivers

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A number of states are readying blueprints for substantial changes under an ObamaCare waiver program, but a renewed push to repeal the law is complicating their plans.

The Affordable Care Act’s 1332 State Innovation Waiver lets states skip some of the law’s regulations if their healthcare plan covers a comparable number of people without increasing the federal deficit. States can apply for the waivers starting this year.

But a revived attempt to repeal the health law is throwing a wrench in those plans, since states don’t know what a new bill will entail. While House Republicans moved forward an amendment in committee to their larger repeal bill on Thursday, the party is far from reaching a consensus.

“The way we are tackling those great uncertainties is that we have to continue to move forward with plans to make the market more stable and proceed along a path that works within the current regulatory framework,” said Oklahoma Health Care Authority Chief Strategy Officer Buffy Heater. “Now we have to of course be mindful of any other proposals that may come up, or any movements that may be made at that time, and be flexible and adapt to whatever changes those might bring.”

Oklahoma is preparing to file a plan with the Centers for Medicare and Medicaid Services later this summer that would implement sweeping changes to the state’s individual insurance market.

If approved, the waiver would establish what Duke University health policy researcher David Anderson calls a “backdoor Medicaid expansion” by shifting subsidies from people between 100 percent to 400 percent of the federal poverty level to those between 0 percent to 300 percent.

The waiver would also allow insurers to charge older members more, restructure subsidies based on age and income, eliminate tiers in favor of two broader categories and require insurers to establish a minimum amount of value-based agreements. Officials also want to regulate outcomes in a number of areas, including mental health, diabetes and obesity.

The stakes are high. Blue Cross Blue Shield of Oklahoma is the only carrier left on the state exchanges, and the state suffers from low enrollment rates. Heater said CMS has promised the state an expedited waiver review but no assurances that things won’t change.


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