A state insurance panel is working on proposals to create special state-generated innovations to improve upon Obamacare, using an amendment to the Affordable Care Act from Oregon Sen. Ron Wyden.
The ideas discussed Wednesday include a state-based public option, allowing insurers to have a lower medical-loss ratio if they invest in social determinants of health and increasing the number of people who can get help with cost-sharing or premium reductions.
The committee members forged ahead with a certain willful suspension of disbelief, given the triumph of Donald J. Trump in the recent presidential election and the Republicans’ vow to use their control of Congress and the presidency to end Obamacare.
“The elephant in the room is that the new administration could drastically change how these waivers can be used,” said Dawn Jagger, the federal policy liaison at the Oregon Health Insurance Marketplace.
But surprisingly, a Wyden waiver may actually be easier to obtain under a Trump administration than under Obama.
The Obama administration has been strict about four principles. Any waiver proposal must be at least as good as what’s available currently under the Affordable Care Act. It must cover at least as many people, be no less affordable and no less comprehensive. It also must not cost the federal government an additional penny.
Throwing a further wrench in any waiver proposal, the federal healthcare.gov technology could not currently accommodate Oregon-specific health alternatives. Largely because of the clunky technology, the state has abandoned its pursuit of a different program, the Basic Health Plan, which would have gotten more affordable health insurance coverage to working-class residents.
But the Trump administration could easily loosen tight restrictions on affordability and comprehension as power shifts to states -- allowing blue states to be more progressive and red states to be more conservative. “You have people coming from both sides who value that sort of state flexibility,” said Anthony Behrens, a state health insurance analyst.
The states with active insurance waivers pending before the federal government -- California, Vermont, Hawaii and Massachusetts -- all still have state-based technology for their health insurance exchanges, unlike Oregon, where the exchange failed.
Massachusetts wants to merge its individual and small-group markets to create a larger risk pool, while still allowing small businesses to offer open enrollment at any time during the year -- which is not allowed in the individual market. Vermont and Hawaii’s waivers also affect their small business health insurance. California would like to allow unauthorized immigrant residents to buy unsubsidized health insurance on the Covered California exchange.
Tim Sweeney, a health policy analyst at the Oregon Health Authority, said it was not uncommon for waivers to get approved by outgoing administrations. “Arizona got a massive [federal Medicaid] waiver in the last months of the Clinton administration and nothing happened to that.”
Sweeney’s insight adds hope to the state’s push to get its big five-year Medicaid waiver for the Oregon Health Plan approved before President Obama’s people leave town on Jan. 20. 2017.
For Secretary of Health & Human Services, Trump has said he will nominate the deeply conservative Congressman Tom Price, R-Ga., who has been one of the staunchest opponents of Obamacare. Price has proposed legislation that would cut 14 million people off Medicaid, and he has long sought to scrap Medicare for a privatized, voucher-style health insurance system for seniors, despite promises from Trump that he would not touch Medicaid or Medicare.
Chris can be reached at [email protected].
