The health care law signed by President Barack Obama includes a waiver that, starting in 2017, would let states take federal dollars now invested in the overhaul and use them to redesign their own health care systems. The “state innovation” provision, Section 1332 of the nearly 1,000-page law, has gotten little public attention. A Democrat in the White House probably would use the waiver to build bridges to Republican governors and state legislators opposed to the law. For a Republican president, state waivers could be the fallback option to avoid the political cost of dismantling Obama’s law and disrupting or jeopardizing coverage for millions of newly insured people, not to mention the upheaval for insurers, hospitals and doctors.
This could be a way for states with very different political perspectives to use the resources provided by the ACA and help the country come to a resolution of this whole question.
Stan Dorn, a health policy expert at the nonpartisan Urban Institute
In addition to preserving the health law’s protection for people with health problems, states would have to cover about the same number of residents while providing comprehensive benefits and financial safeguards against ruinous costs. States also could not add to the federal deficit. States meeting those tests could take hundreds of millions of dollars in health insurance subsidies provided under Obama’s law and shift them, and perhaps combine the innovation waiver with Medicaid and children’s health insurance proposals to create a “super waiver.