I think the Wyden Waiver Watch will become a personal hobbyhorse. Wyden Waivers are also known as Section 1332 waivers and State Innovation waivers in the Affordable Care Act. They allow states to significantly change PPACA’s implementation for the state’s residents as long as the changes result in the same or higher levels of coverage for the same or more people at no greater cost to the federal government than the current system.
If Republicans were interested in healthcare policy and thought that their ideas were superior, this would be an opportunity to not pass up. Wyden waivers go live on January 1, 2017. From a plumbing point of view, states that want to go the Wyden waiver route need to start formulating rough plans now with final details going in late this year or early next year.
The AP has a piece on Wyden Waivers that is somewhat depressing:
Riley said so far there is interest in the waivers among state officials in Hawaii, New Mexico, Minnesota and Vermont.
Vermont is not a surprise, they were initially planning to use a Wyden waiver for single payer, and after they took single payer off the table, they are still interested in significant healthcare financing and delivery reform. Minnesota has been probably the most active embracer of all of the voluntary programs in PPACA as they were the first state to start a Basic health care plan for people who make up to 200% FPL. The Basic plan is a block grant from the Feds to cover people up to 200% FPL instead of putting them on the Exchanges. Hawaii is slightly interesting, but they have a Democratic trifecta with super-majorities in the Legislature. I can see a demand for innovating coverage expansions.
New Mexico is the only state showing interest which is not a usual suspect. It has a Republican governor and lower chamber and a Democratic Senate. It is a state where there are disputes on the nature of medical coverage and social welfare spending plays out at the government level. I would have hoped that several other states would have been interested in more local control and autonomy to play to their political policy preferences of localism instead of centralism while expanding coverage, but we’re not seeing that.