How Oregon’s Waiver Outcome Could Provide Insight

Waiver Weirdness: What the Oklahoma and Iowa Cases Could Mean for Other States Seeking ACA Exemptions
– Fierce Healthcare

Fierce Healthcare turned to Manatt’s Joel Ario, a managing director with Manatt Health, for commentary on current developments in the federal approval process for state reinsurance waivers.
 
Oklahoma officials withdrew the state’s Section 1332 waiver following the Trump administration’s failure to approve its application on time, which was then followed by President Trump asking the Department of Health & Human Services to deny Iowa’s application. Together, the moves are puzzling, as HHS has explicitly encouraged states to apply for waivers that use high-risk pools or state-operated reinsurance programs to stabilize their insurance markets.
 
Ario told the publication that the outcome of Oklahoma’s waiver is likely to reverberate beyond the state, explaining that it would have established a state-based reinsurance program that could have stabilized its individual market and lowered premiums. He also noted that state officials were told that their waiver could be approved in time for the 2018 plan year if they met certain requirements on an expedited timeline.
 
With regard to Iowa, “They really came in at the last minute and proposed something quite ambitious,” said Ario. He argued that if the Trump administration approved Iowa’s waiver, it may have been met with legal challenges. Expediting a unique waiver like Iowa’s without approving a “lookalike” one in Oklahoma may further undermine states’ confidence in the process.
 
According to Ario, as the public comment period for Oregon’s waiver draws near, an approval or failure could shed light on the administration’s behavior with Oklahoma. If Oregon’s waiver is approved, it might suggest that there was something about Oklahoma’s waiver that led the federal government to renege on the agreement it had with the state.
 
However, if Oregon’s waiver isn’t approved, “then it does suggest that they’re backtracking on what they promised,” said Ario.
 

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