Governors urge Congress to expand state flexibility in health care coverage

With health care premiums increasing, a bipartisan group of governors are asking Congress to give them greater control and flexibility into how their states implement the Affordable Care Act (ACA) by supporting and broadening state innovation waivers. 

Governors from Massachusetts, Montana, Tennessee, Utah and Colorado testified Thursday on Capitol Hill to the Senate Committee on Health, Education Labor and Pensions (HELP). Their testimony was part of ongoing Senate hearings on how to help stabilize insurance premiums, specifically as it relates to the individual insurance marketplace. 

Governor Steve Bullock, a Montana Democrat, thanked Congressional lawmakers for inviting the group of state leaders, saying that governors were on the front lines of implementing health care policy crafted in Washington. “Your recognizing of our role in this debate is incredibly significant,” said Bullock.

Bullock, who said 8 percent of those insured in his state currently get their coverage on the individual marketplace, called for Congress to provide guaranteed funding of Cost-Sharing Reductions (CSR’s) up to 2019 in order to lower deductibles and out-of-pocket costs, as well as create temporary state stability funds for reinsurance pools to help pay for high-cost patients. 

Another facet of stabilizing the insurance market that all five governors expressed as a “must do” for Congress: provide greater latitude for state control by broadening the 1332 waiver

Section 1332 of the current ACA law specifically addresses state innovation waivers, which are designed to allow states to experiment in how they provide residents with access to high quality, affordable coverage while still retaining the basic pillars and protections of the ACA.  

It also permits a state to request permission to waive specific provisions of the law, including the individual and employer mandates, as well as requirements for qualified health plans, essential health benefits, tax credits and subsidies, and exchanges.

To obtain a waiver, a state must demonstrate its plan would not increase the federal deficit, would not reduce the number of people with health coverage, and would not reduce the affordability or comprehensiveness of coverage. “We need Congress to offer flexibility to address the unique challenges we face,” said Republican Gov. Bill Haslam of Tennessee, urging lawmakers to further expedite the waiver approval process.

Utah Republican Gov. Gary Herbert seconded those sentiments, saying “states need to determine their own health care destiny,” adding that by expanding the waiver program, “states will innovate their own practical choices for improvement.”

“Consider a health care future that gives back to the states a lion’s share of responsibility, returning control to the states is prudent policy but also prudent politics,” added Herbert.  

A vocal advocate for health care reforms, Democratic Gov. John Hickenlooper joined in the call for flexibility, pointing to his own bipartisan blueprint for market stabilization, crafted with the help of Gov. John Kasich, an Ohio Republican, as well as Bullock. 

“The 1332 waivers gives states the ability to innovate at lower costs, while ensuring basic guidelines are met,” said Hickenlooper. He added, “We’re asking for a streamlined waiver submission and approval process and flexibility in applying budget neutrality, all of which can be done in a fiscally responsible way.”

Hickenlooper emphasized to lawmakers that governors and states have been proven innovators since before the ACA was enacted, but that Congressional intervention is needed to help craft “responsible reforms.”

“We’re like start-ups, we learn from our mistakes, tweak and constantly improve, but fine is never good enough, it’s time for the federal government to work with us, not against us,” Hickenlooper said. 

The committee is set to continue their discussion on state flexibility as it related to stabilizing the market with their next hearing scheduled for Tuesday.  


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