Skip to main content
Sister Publication Links
  • ESG: THE IMPLEMENTATION IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Digital Health
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Unwell in America
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Policy
July 16, 2021 04:14 PM

State public options may suffer if CMS is too stingy with federal dollars

Michael Brady
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Modern Healthcare Illustration / Getty Images

    The Biden administration's plan to retool Obamacare marketplaces could open the door to more states offering a public option, but the president's goal to expand coverage could suffer if CMS doesn't give states enough leeway to spend federal money.

    The language around Section 1332 waivers in the market modernization proposed rule is similar to the Obama administration's 2015 guidance but features more explicit language about improving health equity. Biden's team wants states to apply for waivers that would increase the number of people covered, offer more comprehensive coverage, make comprehensive coverage more affordable or address health equity and the social determinants of health.

    It's a significant departure from the Trump administration's exchange policies, which had primarily focused on making coverage more affordable by allowing consumers to buy skimpier plans.

    "The Biden administration really wants to ensure that the plans people purchase have the coverage and cost-sharing protections that were originally intended under the ACA," said Ruth Liu, an expert on the ACA and commercial insurance at consultancy Avalere Health.

    That could be a problem for states like Georgia that want to offer plans with worse benefits or cover fewer people. CMS is reviewing the state's Trump-era plan to privatize its exchange.

    "The administration has sent a signal to states that it's going to be less flexible regarding alternative benefit designs with a more limited scope of coverage and higher cost-sharing," Liu said.

    Ideology and consumer demand for more affordable coverage options, especially to meet short-term needs, initially drove the Trump administration to empower states and insurers to offer marketplace coverage that doesn't meet the ACA's requirements.

    But it appears that the Biden administration sees a smaller role for those types of plans in the future.

    Congress boosted financial assistance for ACA premiums in March's $1.9 trillion American Rescue Plan, making comprehensive health coverage more affordable for more people. While those changes are temporary, the Biden administration and congressional Democrats are pushing to make them permanent.

    "Affordability is less of a concern for many lower- to lower-middle-income individuals and, to some extent, higher-income individuals whose premium contribution is now capped at 8.5% of their income," Liu said.

    If those subsidies are made permanent, it could diminish the demand for lower-cost alternatives like association health plans or short-term, limited-duration insurance.

    But states could run into trouble if they ask for waivers that increase federal spending because the rule's language suggests the Biden administration might not approve them.

    "I don't know what it means for more ambitious proposals, especially those with a public option. The thing to watch is how they approach budget neutrality," said Katie Keith, a health law professor at Georgetown University.

    State insurance commissioners, marketplace executives and consumer advocates have asked the Biden administration to allow more budget flexibility for states that want to expand coverage through their marketplaces. They're worried that states could pay the price if they lower marketplace premiums and too many people enroll in coverage.

    "The state is at-risk if a reform at the state level increases the number of people that are covered," said Joel Ario, managing director at Manatt Health. He's a former state insurance commissioner and led HHS' Office of Health Insurance Exchanges.

    That seems counterintuitive to many policymakers and consumer advocates in light of the Biden administration's other efforts to increase marketplace-based coverage through an expanded open enrollment period and greater consumer education and outreach.

    "They've clearly expressed an interest in covering everybody that's eligible. So, if states can figure out how to do that at a cheaper cost, I think they'll be supportive of that," Ario said.

    But states need more clarity because they don't want to be left holding the bag if they enroll more people that are already eligible for coverage, he said.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    payment_WEB.jpg
    CMS proposes hospice payment bump
    payments-up_i.png
    CMS 2024 Medicare Advantage rate notice tweaks risk adjustment program
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Digital Health
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Unwell in America
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing