To 1332, or Not to 1332: That is the Question
Much is abuzz with the Affordable Care Act’s (ACA) Section 1332 State Innovation Waivers. Available in 2017, 1332 waivers give states authority to change how people get health coverage. In addition to allowing states to considerably change certain key coverage provisions of the ACA, waiver conversations also offer opportunities for states to reflect on their health care system priorities and needs – whether those require a waiver or not.
The 1332 waiver workshop at Community Catalyst’s Consumer Voices for Coverage (CVC) convening in late September was packed with advocates eager to learn more about the waiver process and how to spark dialogue with policymakers in their states. Most advocates identified that their organizations and coalitions are just beginning to scratch the surface of 1332 waivers, while a handful of advocates are already involved in discussions with their state leaders on potential waiver applications. We know 1332 waivers offer a range of possibilities for change, but there isn’t a lot of meat on the bones in terms of what a successful waiver application will look like.
Prepare for a consumer-focused dialogue
Amidst this uncertainty, advocates can be proactive by preparing for potential waiver discussions and prioritizing consumer engagement in the waiver process. We created a fact sheet and a set of consumer-focused principles to support advocates as they learn about 1332 waivers. Advocates should use these resources to equip their coalitions and partners for future dialogue with state policymakers.
Set the stage for meaningful consumer engagement
In states considering a 1332 waiver, the process has provided highly valuable opportunities to think broadly about what health reform initiatives a state would like to pursue. In Arkansas, health care reform task force discussions involved considerations for a 1332 waiver to make changes to the state’s Medicaid program. Even though policymakers eventually concluded that a 1332 waiver may not be necessary to achieve the state’s desired reforms, waiver conversations are not completely off the table. Marquita Little, Health Policy Director of Arkansas Advocates for Families and Children and an advisory council member to the state’s health care reform task force, elevates the consumer voice by using her organization’s ten consumer principles to make sure health care system changes work for all Arkansans – whether that requires a 1332 waiver or not.
Meanwhile, consumer advocates in Minnesota are imagining how to better serve consumers through a 1332 waiver, whether through expanding lower-income coverage options or to create more seamless coverage overall. “A 1332 waiver provides a new opportunity to explore how we can make the ACA work even better in Minnesota,” says Liz Doyle, Associate Director of Take Action Minnesota.
We still have a lot to learn about the range of reforms a state can pursue with a 1332 waiver. However, what remains clear is the strong need for advocates to actively engage with policymakers to ensure that all proposed waiver applications further benefit and protect consumers.
Community Catalyst Private Insurance Team