Section 1332 waivers offer states an opportunity to avoid the centralized policies of the ACA and craft innovative health insurance reforms specific to their distinctive populations and markets without increasing federal spending.

Key points

  • A number of the ACA’s centralized regulations have stifled innovation, de-stabilized the individual health insurance market, and contributed to an increase in health insurance costs.
  • Linked to the rise in costs is a decline in enrollment in individual market plans among those people without a premium subsidy as well as a corresponding increase in the number of uninsured.
  • Although a number of states have been approved for Section 1332 waivers, with few exceptions these have been limited to the implementation of re-insurance programs.
  • Early experience shows that Section 1332 waivers have the ability to lower premium costs and to stabilize the individual health insurance market.