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Tuesday, April 5, 2016

Could Maryland have a public option next year under the Affordable Health Care Program?

    For those of us who are frustrated with the fact that the United States is the only western developed country without universal health care we recognize that moving in that direction will not happen with one piece of legislation. We recognize that it will only happen incrementally. One incremental move might be made by some states next year. Here is that opportunity explained and how Maryland might be one of those states.
     States often have the ability to request waivers to federal regulations if they seek to develop ways to improve on federal programs. The federal agency that administers the program has the authority to grant a waiver if they determine that the waiver doesn't undermine the intent of the law. Often the waivers are used as state experiments to test new methods to administer a federal program. The most interesting waiver requests might come from progressive states, like Maryland, to set up a "public option" that was left out of the Affordable Care Act in a compromise to win some needed votes for passage.  The difference between a public option and a single payer option is that with a public option a state administered option still competes with other private insurance options.  Single payer option is like what Canada has and only the public option is available.  Progressives see the public option as eventually becoming so popular because it might offer better coverage at a lower cost that it might reach the level of being a "single payer" where it exists.  That is why it was such a tough compromise when the public option was dropped in the Affordable Care Act.  Next year states will be able to request waivers to the Affordable Care Act.  Next year a waiver request to a Democratic administration from a state to set up a public option would probably be approved. Here is how that might play out according to an article in the website Modern Health Care:

   " A little-noticed clause in the Affordable Care Act will provide the next president with an option for allowing states to restructure their healthcare systems. The law signed by President Barack Obama includes a waiver that, starting in 2017, would let states take federal dollars now invested in the overhaul and use them to redesign their own healthcare systems.
    Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.  State Innovation Waivers allow states to implement innovative ways to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state as would be provided coverage absent a waiver, and does not increase the federal deficit.
     The "state innovation" provision, Section 1332 of the nearly 1,000-page law, has gotten little public attention.   But "you would be hard pressed to find a state that doesn't know what Section 1332 is," said Trish Riley, executive director the National Academy for State Health Policy, a nonpartisan forum for state policymakers. "It provides some opportunity for taking the rough edges" off the Affordable Care Act, as the law is known.

     Riley said so far there is interest in the waivers among state officials in Hawaii, New Mexico, Minnesota and Vermont. But the Obama administration has yet to issue regulations that would set the ground rules for granting them.   Next year's legislative battles might be around adding a public option to the program in Maryland. With a Republican Governor this maybe the biggest legislative battle next year.  "This could be a way for states with very different political perspectives to use the resources provided by the ACA and help the country come to a resolution of this whole question," said Stan Dorn, a health policy expert at the nonpartisan Urban Institute. "Whoever is in the White House in 2017 and beyond is going to have a lot of flexibility without having to change the statute."

   So here is how it might play out in Maryland.  A Democrat is elected President in 2016.  In the 2017  Maryland legislature passes a bill to request a waiver to set up a public option in Maryland.  The Governor could sign it or veto it.  If it was vetoed then the Legislature could override the veto and have the request sent to the feds.  One battle that might make for an interesting battle in the 2017 Maryland Legislature.


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