In the years since the Affordable Care Act (ACA) was enacted, policymakers continue to adjust to meet the changing landscape of insurance and medical care. The Centers for Medicare and Medicaid Services (CMS) recently announced four new Medicaid waiver concepts designed to promote more affordable, flexible health insurance coverage options through State Relief and Empowerment Waivers. The primary goal of these changes is to provide flexibility, spur innovation, and empower state control over how subsidies are allocated to avoid forcing states, providers, and the insured into a one-size-fits-all approach. The waiver concepts include:
Account-Based Subsidies
The Account-Based Subsidies adjustment allows states to develop accounts similar to health savings accounts (HSAs) or flexible spending accounts (FSAs). This option expands payment options and could simplify reimbursement and payment for those involved.
State-Specific Premium Assistance
This concept would allow states to develop their own subsidy structure for paying premiums and determine how those subsidies are rewarded. States would be able to determine what types of health insurance would be covered by subsidies, potentially opening the door for short-term plans.
Adjusted Plan Options
This concept allows states to provide financial assistance for different types of health insurance plans, which may increase consumer choice and make coverage more affordable for individuals. Used in conjunction with the Account-Based Subsidy waiver concept, states could provide subsidies that allowed individuals to purchase the coverage that is right for them and use any remaining funds to offset out-of-pocket expenses.
Risk Stabilization Strategies
In order to address risks associated with individuals with high healthcare costs, the waiver concept could provide risk stabilization through reinsurance programs and pooling. These models include a claims cost-based model, a conditions-based model, and hybrid conditions and claims cost-based model. Reinsurance programs have seen success in the past, with the Maryland program forecast to reduce market premiums by 13.2% in 2019.
The adjustments are not without controversy, however. While the intent is to improve health and drive innovation, there is some concern that these changes will inhibit growth, increase costs, and lower the overall quality of care system-wide. CMS encouraged states to couple waiver concepts with innovative approaches that meet the unique needs of their population.
