A New Era for Section 1332 of PPACA

On October 22, 2018, the United States Departments of Health and Human Services and Treasury (the Departments) released guidance, entitled State Relief and Empowerment Waivers, that relaxes the requirements for states seeking waivers under section 1332 of the Patient Protection and Affordable Care Act (PPACA).¹  Section 1332 permits states to waive certain provisions of PPACA and receive pass-through funding for any savings generated by the waiver.  According to the Centers for Medicare & Medicaid Services (CMS), the purpose of the guidance is to allow states to “increase choice and competition within their insurance market while protecting people with pre-existing conditions.”² The changes in policy align with previously implemented Trump administration policies as well as policies proposed during the Republican attempt to repeal and replace PPACA in 2017. To-date eight states have been granted section 1332 waivers, which have created reinsurance programs in each instance, except for Hawaii.³