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Waivers, Waivers, Waivers, and More Waivers

It seems that the term “waiver” is showing up a lot these days. That’s no surprise considering that thousands of waivers related to the health law have either been granted or are under consideration. These waivers grant flexibility to states, health plans, employers, and even individuals regarding mandates under the new(ish) health law. Let’s go through the three types of waivers attracting the most attention right now.

S 248 – Empowering States to Innovate Act (Endorsed by Obama on March 1)

We are well aware of issues that a majority of states have with federal reform. They criticize the law for providing too much federal oversight and setting rigid requirements on state spending. S 248 allows states to come up with their own ideas on expanding coverage and decreasing costs starting in 2014 – three years before the federal law allows – as long as they still achieve the main goals of health reform. These goals include 1) Not increasing the federal deficit, 2) Covering the same number of residents as provisions under ACA would, and 3) Offering as affordable and comprehensive care as ACA offers. Sounds simple, right? It will be interesting to see what sort of systems the approved states formulate.

Mini-Med Waivers (1,040 granted since 2010)

New provisions requiring plans to raise annual limits might prove cumbersome for smaller, low-wage employee plans. Many low-wage employers (including chain restaurants) offer “mini-med” plans. These plans provide limited insurance with annual caps as low as $2,000. With the federal legislation providing mandated minimum caps starting at $750,000 in 2011 and increased each year until they are completely eliminated in 2014, many of these plans would have to reduce benefits and/or raise premiums. The mini-med waivers allow these plans to continue offering annual limits with the assumption that in 2014, their low-wage employees will be eligible for coverage in the Exchange and the need for mini-med plans will be reduced.

HR 984 – Health Care Waiver Fairness Act of 2011 (Announced yesterday)

With all these waivers being granted for states and businesses, some congressional leaders argue that individuals and other entities should have rights to waivers as well. HR 984 would allow individual consumers, as well as health plan administrators and employers, to apply for waivers from mandates in the health law relating to an instance where the mandate would cause a decrease in access to care or an increase in premiums.