ACA Round-Up: 1332 Waiver News From Iowa And Minnesota; Big Blow To Graham Cassidy

Iowa has submitted a supplement to its application for a state innovation waiver under section 1332 of the Affordable Care Act. One of the issues raised by its application, as noted in an earlier post, was that its proposed waiver would eliminate cost-sharing reductions for low-income enrollees.  This raised concerns as to whether the proposal satisfies a section 1332 requirement that a waiver program “will provide coverage and cost-sharing protections against excessive out-of-pocket spending that are at least as affordable” as ACA coverage. Under the supplement it submitted, Iowa offers to compensate insurers for reducing cost sharing for enrollees with incomes between 133 and 150 percent of the federal poverty level. Individuals in this income range would be offered coverage with a 94 percent actuarial value, subject to a maximum out-of-pocket of $1,000 for individuals and $2,000 for families. Iowa asserts that providing cost-sharing reductions to these individuals would cost $14 million for 2018 and might increase enrollment, but would not increase the federal deficit. The ACA extends cost sharing reductions to enrollees with incomes up to 250 percent of the federal poverty level. Enrollees with incomes between 150 and 200 percent of the federal poverty level who enroll in silver plans must be provided with 84 percent actuarial value coverage and reduced out-of-pocket limits. The Iowa supplement does not explain how enrollees with incomes between 150 and 250 percent ...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage Source Type: blogs