Republicans are considering giving President Trump’s Department of Health and Human Services less power over whether a state can opt out of health insurance regulations than the agency has now.
A draft deal to let states opt out of certain Obamacare insurance regulations released Thursday appears to not give the Department of Health and Human Services much authority over the waiver. The regulations on the table are mandates that force insurers to cover 10 essential health benefits and adopt a price control that prevents them from charging sicker people more than healthy people.
No legislative text has been released for the waiver process, but the draft hints that it would not give the Trump administration as much latitude in approving waivers as it does for Medicaid.
The language in the draft says the secretary of Health and Human Services “shall approve applications within 90 days of determining that application is complete.”
By going with the word “shall,” “that to me doesn’t sound like the secretary is making any substantive or evaluative judgment,” said MaryBeth Musumeci, associate director of the Program on Medicaid and the Uninsured at the nonpartisan Kaiser Family Foundation. “It is not clear if this is a drafting problem or what the authors meant.”
To receive a waiver, a state has to attest that it intends to lower premiums and not reduce coverage. However, the draft doesn’t outline how a state would prove that.
The waiver language would address a key qualm from conservatives who worry that any waiver could become more stringent under a Democratic administration and block states from opting out of the Obamacare regulations.
Conservatives also didn’t want the waiver to be too difficult for states to get.
“A waiver should be easily granted,” Rep. Mark Meadows, R-N.C., said this month. Meadows is the leader of the conservative House Freedom Caucus.
It is not clear when the legislative text of the amendment to the American Health Care Act, which would gut Obamacare, will be released. The GOP leadership is holding a conference call with its members Saturday, but it is expected to focus on other topics as well, such as government funding.
While the White House initially hoped to have a new vote on a healthcare deal next week, it has backtracked on that timeframe.
The lack of HHS authority in the draft stands in stark contrast to the current waiver that lets a state make changes to their Medicaid programs, which has been employed by states that want to expand Medicaid under Obamacare.
The Medicaid waivers let states experiment with their health insurance programs for low-income residents, including toying with new ways on how to expand eligibility or provide services not typically covered by Medicaid.
The process gives HHS the “discretion to determine whether a certain request furthers program purposes,” Musumeci said.
Several red states that have expanded Medicaid used their waivers to include requiring some expansion recipients to contribute to their premiums. That was an approach adopted by Indiana under former governor and now Vice President Mike Pence. Seema Verma, the consultant instrumental in setting up that program, is now the director of the Centers for Medicare and Medicaid Services.
A day after her confirmation, Verma and HHS Secretary Tom Price sent a letter to states signaling more latitude in getting Medicaid waivers. However, no states have been granted any Medicaid waivers.
“We are really waiting because there haven’t been major waiver approvals,” Musumeci said.
