The Centers for Medicare and Medicaid Services (CMS) is asking for ideas that could create a middle way forward on how the U.S. commercial health insurance market works.
Many conservative Republicans in Congress still want to repeal the entire Affordable Care Act (ACA) health system framework, and a court ruling on the Texas v. USA case or another court case could help make that happen.
The ACA is a two-law statutory package that includes the Patient Protection and Affordable Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA).
Many Democrats are promoting Medicare for All proposals that could create a single-payer, federally run health finance system, or at least a major new Medicare buy-in program.
CMS has now posted two documents that could shape what the commercial health insurance market looks like if most or all of the current ACA framework stays in place:
One is a formal request for comments on how states could use the new CMS ACA rule waiver guidelines, which were completed in October.
The State Relief and Empower Waiver (SREW) program, which was created by PPACA Section 1332, could give states more ability to change ACA programs and rules, without Congress changing any provisions in the ACA.
Officials at CMS and its parent, the U.S. Department of Human Health and Services, believe that HHS has the ability to make some policy tweaks, within the ACA medical underwriting and benefits standards “guardrails,” but adjusting the requirements in ways that could increase access to coverage.
The other new document is a set of new guidelines that states can use to create their own, entirely state-based ACA exchange programs, or state-based ACA exchange programs that use the federal government’s own HealthCare.gov system to handle some of the work.
States that want to apply for SREW program ACA rule waivers might want to consider setting up their own state-based exchange programs, or SBE programs, rather than relying on HealthCare.gov to provide exchange services, CMS officials say in the new state-based exchange creation guidelines.