State Options Under ACA Section 1332

Section 1332 of the Affordable Care Act (ACA) gives states significant flexibility to change many elements of their individual and small group private health insurance markets. The ACA provided flexibility for states to submit waivers (commonly known as Section 1332 waivers) that can go into effort beginning in 2017, to waive certain key provisions of the health insurance marketplaces (also known as Exchanges). The waivers allow flexibility for a number of provisions including the individual and employer mandate, the marketplace structure and premium and cost-sharing assistance. The waivers also include guardrails limiting states from making certain kinds of changes. For instance, states cannot modify the insurance reforms including dependent coverage up to 26 and prohibition on lifetime and annual limits.

There are a number of considerations for states to consider as they examine their options under Section 1332 waivers. The NGA Center for Best Practices (NGA Center) is working closely with states to help navigate key questions and concepts for Section 1332 waivers The NGA Center also has experience working with states to develop and implement Section 1115 Waivers, which provide flexibilities for state Medicaid programs. State 1115 Waivers have multiplied and continually innovated throughout the history of the Medicaid program, and the NGA Center is expanding its convening and technical assistance role to focus on Section 1332 options to help states create novel improvements in their private health insurance marketplaces.

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