The talking point from “private option” Medicaid expansion advocates over the past two years has been that the program would provide Arkansas flexibility in the administration of Medicaid.
Instead of flexibility, we got rigidity: Arkansas couldn’t even manage to get minor reforms to the “private option,” like an enrollee work requirement, before reauthorizing the program earlier this year.
And now state bureaucrats are saying we can still have flexibility, but we’ll just have to wait until 2017 — when 1332 waivers can be implemented by the state. It’s almost as if we’ve learned nothing from the “private option” bait-and-switch that we’ve endured for the last two years.
Here’s Cheryl Smith Gardner, executive director of the Arkansas Health Insurance Marketplace, talking about how great 1332 waivers are:
I have not heard anyone yet say, ‘Oh, I don’t want this kind of flexibility in my state.’ Whether you’re left or you’re right, you want what you want. and so I frankly haven’t heard anyone say (1332 waivers) are a bad idea.
Unfortunately, legislators who expect real flexibility through 1332 waivers are going to be sorely disappointed.
Here’s the Center on Budget and Policy Priorities on 1332 waivers:
Also known as “1332 waivers” for the section of the ACA creating them, the waivers are attracting attention as a way states may pursue their own approaches to expand coverage, including alternatives that would represent a significant departure from the ACA’s standards and requirements.
Many aspects of the ACA, however, cannot be waived. Moreover, the ACA establishes several conditions that states must satisfy if they diverge from ACA standards and requirements. These conditions ensure that states using the ACA’s waiver authority continue to meet the overarching goals of health reform, such as extending access to affordable health coverage that provides a basic level of benefits.
So, in short, 1332 waivers provide states with “flexibility” from Obamacare as long as states use this supposed “flexibility” to “continue to meet the overarching goals of” Obamacare. More precisely, states can use the 1332 waiver program to experiment as long as they provide benefits that are at least as generous as Obamacare, constrain cost sharing at least as much as Obamacare, and cover as many people as Obamacare.
That doesn’t sound like much flexibility at all! It sounds uncomfortably like Henry Ford’s version of flexibility, who famously offered to sell cars to his customers in any color — “so long as it is black.”
It’s not so much that 1332 waivers are a bad idea: it’s just that they aren’t a particularly good idea. From a conservative, limited- government perspective, it is hard to see what progress they promise. And a waiver — unlike a change in the law — has an expiration date.
As Dan Greenberg, AAI President, also noted recently, 1332 waivers don’t allow for reform of Arkansas’ Medicaid program. Ostensibly, the legislature’s Health Care Task Force wants to bring about major reforms to the state’s entire Medicaid program. This is a worthy goal. Unfortunately, this is something that can’t be accomplished through 1332 waivers.
We’ll have more about 1332 waivers next week.