• Menu
  • Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Before Header

  • About Us
  • Lexicon
  • Contact Us
  • Our Store
  • ↑
  • ↓
  • ←
  • →

Balloon Juice

Come for the politics, stay for the snark.

The cruelty is the point; the law be damned.

You are either for trump or for democracy. Pick one.

This year has been the longest three days of putin’s life.

I’d hate to be the candidate who lost to this guy.

I swear, each month of 2025 will have its own history degree.

Sometimes the world just tells you your cat is here.

They think we are photo bombing their nice little lives.

if you can’t see it, then you are useless in the fight to stop it.

Republicans are the party of chaos and catastrophe.

“A king is only a king if we bow down.” – Rev. William Barber

I desperately hope that, yet again, i am wrong.

You know it’s bad when the Project 2025 people have to create training videos on “How To Be Normal”.

Mediocre white men think RFK Jr’s pathetic midlife crisis is inspirational. The bar is set so low for them, it’s subterranean.

The low info voters probably won’t even notice or remember by their next lap around the goldfish bowl.

Oh FFS you might as well trust a 6-year-old with a flamethrower.

These are not very smart people, and things got out of hand.

Our job is not to persuade republicans but to defeat them.

Republicans seem to think life begins at the candlelight dinner the night before.

When we show up, we win.

Democracy cannot function without a free press.

If rights aren’t universal, they are privilege, not rights.

Let me file that under fuck it.

When someone says they “love freedom”, rest assured they don’t mean yours.

Red lights blinking on democracy’s dashboard

Mobile Menu

  • Seattle Meet-up Post
  • 2025 Activism
  • Targeted Political Fundraising
  • Donate with Venmo, Zelle & PayPal
  • Site Feedback
  • War in Ukraine
  • Submit Photos to On the Road
  • Politics
  • On The Road
  • Open Threads
  • Topics
  • COVID-19
  • Authors
  • About Us
  • Contact Us
  • Lexicon
  • Our Store
  • Politics
  • Open Threads
  • 2025 Activism
  • Garden Chats
  • On The Road
  • Targeted Fundraising!
You are here: Home / Anderson On Health Insurance / 1332 as a state block grant

1332 as a state block grant

by David Anderson|  January 3, 20188:10 am| 4 Comments

This post is in: Anderson On Health Insurance

FacebookTweetEmail

The Section 1332 waiver in the Affordable Care Act (ACA) is a state innovation waiver.  It allows states to meet or beat the standard coverage of the ACA through whatever means possible. The state can use the funds that the federal government would have used for Premium Tax Credits (PTC) and Cost Sharing Reduction (CSR) subsidies to fund the state plan. There are four major guardrails that measure whether or not a state’s proposal qualifies.  A 1332 must:

  • Cover at least as many people
  • Cover those people at least as well
  • Cover those people with the same or less cost sharing
  • Cost the federal government no more than the federal government would otherwise spend.

The current guidance tightly defines these criteria.  The Alexander-Murray Senate bill proposed looser criteria.

There have been a good amount of interest in states using 1332 waivers.

http://www.ncsl.org/research/health/state-roles-using-1332-health-waivers.aspx

Some of the waivers are minor technical changes; Hawaii is using an approved 1332 to close the state SHOP exchange and use that funding for another pre-ACA state program that performed a similar function.

Other changes are significant.  Alaska, Oregon and Minnesota have approved re-insurance waivers that use some of the APTC/CSR money to fund reinsurance in order to bring down non-subsidized premiums.  Iowa and Oklahoma have very ambitious, conservative leaning proposals that they pulled in the Fall of 2017 because the Center for Medicare and Medicaid Services was not going to rush their analysis.   Idaho has an extremely creative waiver it released that integrates Medicaid and the ACA in a creative fashion with creative rules lawyering.

One of the interesting things, to me at least, is that the waiver process is not being framed as a state level block grant.  The states are given quite a bit of freedom to choose a “better” method that fits their local needs.  Once the waiver is approved, the federal government writes a big check and then performs light monitoring of the state’s customized program.  That to me sounds like a block grant.

 

 

FacebookTweetEmail
Previous Post: « On the Road and In Your Backyard
Next Post: “They’re going to crack Don Jr. like an egg…” »

Reader Interactions

4Comments

  1. 1.

    guachi

    January 3, 2018 at 8:17 am

    I don’t mind block grants. But most block grants are disguised as cuts. As long as there is a real attempt to ensure states adhere to your four bullet points I’m fine with these waivers.

  2. 2.

    Victor Matheson

    January 3, 2018 at 10:24 am

    And I would follow up guachi by noting that block grants often come with very few strings attached, i.e., “Here’a a bunch of money for education, but it you want to use it to reduce property taxes, we’re ok with that.”

    I, too, am ok with waivers as long as you have an effective and powerful oversight bureaucracy both during the initial approval process and while examining outcomes.

  3. 3.

    PhoenixRising

    January 3, 2018 at 10:52 am

    Cover those people with the same or less cost sharing

    Cost sharing=between state & Fed here, not ‘no co-pays or premiums’, right?

    Here in New Mexico, we can afford to cover everyone, because we have enough PCPs and allied health providers who can afford to work for reasonable rates–everyone takes Medicaid. What we need is a 1332 compliant system that allows the working poor, which we lead the US in by share of adult population, to pay a $15-55/mo premium and a $5-20/service co-pay, sliding scale. The math works here, because we have so many healthy younger folks who can afford that.

    During open enrollment my only mitzvah this year was the blacksmith who works on my kid’s horses: He’s been appealing an SSDI denial for 23 months, since he got damn near killed at the racetrack (racehorses can’t be given a relaxing cocktail before they compete, for both obvious reasons and to prevent tampering, and they don’t all like having their hooves examined).

    He makes decent money, but it’s all been cash since 2015. He doesn’t need the stipend from SSDI, but he did not know that he could apply for an exchange plan & get enrolled in Medicaid because he appears indigent on paper. He’d be a LOT happier if he could tell everyone he knows that it’s a state plan that charges him a little bit, and so would the budget.

    He saw a doctor yesterday, at last, who has referred him to the private practice that takes mostly VA referrals. He’s been treated for the injury’s effects, and will be able to get a prosthetic that allows him to walk right, once the swelling is down.

  4. 4.

    David Anderson

    January 3, 2018 at 10:56 am

    @PhoenixRising: Nope, Cost-sharing means same or lower co-pays/deductibles/out of pocket maxes.

Comments are closed.

Primary Sidebar

On The Road - BarcaChicago  - Off the Gunflint Trail/Boundary Waters 8
Image by BarcaChicago (7/11/25)

World Central Kitchen

Donate

Recent Comments

  • moonbat on The Ongoing Texas Tragedies (Jul 12, 2025 @ 9:13am)
  • Nukular Biskits on The Ongoing Texas Tragedies (Jul 12, 2025 @ 9:08am)
  • Baud on The Ongoing Texas Tragedies (Jul 12, 2025 @ 9:06am)
  • suzanne on Saturday Morning Klown Show Open Thread: GOP Falling Into the Pit They Have Dug (Jul 12, 2025 @ 9:06am)
  • prostratedragon on Saturday Morning Klown Show Open Thread: GOP Falling Into the Pit They Have Dug (Jul 12, 2025 @ 9:04am)

Balloon Juice Posts

View by Topic
View by Author
View by Month & Year
View by Past Author

Featuring

Medium Cool
Artists in Our Midst
Authors in Our Midst
No Kings Protests June 14 2025

🎈Keep Balloon Juice Ad Free

Become a Balloon Juice Patreon
Donate with Venmo, Zelle or PayPal

Calling All Jackals

Site Feedback
Nominate a Rotating Tag
Submit Photos to On the Road
Balloon Juice Anniversary (All Links)
Balloon Juice Anniversary (All Posts)
Fix Nyms with Apostrophes

Social Media

Balloon Juice
WaterGirl
TaMara
John Cole
DougJ (aka NYT Pitchbot)
Betty Cracker
Tom Levenson
David Anderson
Major Major Major Major
DougJ NYT Pitchbot
mistermix

Keeping Track

Legal Challenges (Lawfare)
Republicans Fleeing Town Halls (TPM)
21 Letters (to Borrow or Steal)
Search Donations from a Brand

Feeling Defeated?  If We Give Up, It's Game Over

Site Footer

Come for the politics, stay for the snark.

  • Facebook
  • RSS
  • Twitter
  • YouTube
  • Comment Policy
  • Our Authors
  • Blogroll
  • Our Artists
  • Privacy Policy

Copyright © 2025 Dev Balloon Juice · All Rights Reserved · Powered by BizBudding Inc

Share this ArticleLike this article? Email it to a friend!

Email sent!