The U.S. Supreme Court is expected to make headlines this summer with its ruling on the latest challenge to the Affordable Care Act: the case known as King vs. Burwell.
At issue is whether a handful of words buried deep in the law are essentially a typo, or a legal time bomb that may prevent millions of people from getting subsidies to help buy health insurance. Those opposed to the ACA are hoping for the latter, since this could potentially render the law unworkable in several dozen states.
What neither ACA proponents nor opponents seem to fully appreciate is that the law does contain detailed language in another place — known as Section 1332 ‘‘innovation waivers” — that allows states to get rid of the law’s key pillars, including insurance marketplaces like MNsure or the individual mandate to buy health insurance, beginning in 2017. But there’s a big catch.
States would have to provide equivalent or better coverage than the ACA, and prove it to federal health officials.
But the federal government would also help foot the bill for an approved alternative approach, such as by allowing states to use federal funding currently flowing to subsidize low-income people’s purchase of private health plans.
Those who want to blow up the ACA in their states don’t need to bet on the Supreme Court. Sec. 1332 is a surer approach, if opponents can do better with an alternative.
There’s a lot to like about the innovation waivers for ACA’s proponents, too. This section of the law is not a reset button to go back to pre-ACA days. Instead, it’s a timely way to evaluate what has worked during the federal law’s rollout and then allow the states to build on this.
In Minnesota, the waiver is a chance to think big and to improve on the state’s medical assistance programs with an eye toward not only improving coverage numbers but improving public health outcomes. Long-term care should be part of this conversation.
It’s also an opportune time to re-evaluate financing for these programs (the tax supporting MinnesotaCare sunsets in 2019), consider more efficient ways to run separate assistance programs and find ways to make the private marketplace more affordable for everyone.
Minnesota is in a solid position to leverage innovation waiver opportunities. A new 29-member health care task force was created this past legislative session to tackle this daunting but exciting assignment.
Members have not yet been named (see our accompanying “wish list”). Those tapped need deep expertise in health care or information technology. Small and large businesses also need robust representation. Minnesota’s wealth of academic experts should be tapped.
Above all, appointees need a civic-mindedness that will allow them set ideology or professional interests aside and embrace the big-picture opportunity at hand. No ACA rock-throwers nor cheerleaders need apply. What’s best for Minnesotans who need help with health insurance must be the priority.