Senate Republicans may have shielded part their new health coverage bill draft from impact analysis by putting a provision for changing Affordable Care Act product rules in a short waiver program provision.
The drafters of the new Better Care Reconciliation Act of 2017 draft have put the waiver provision in Section 206.
PPACA Section 1332 Waivers
The Affordable Care Act is actually a statutory package. Part of it comes from the Health Care and Education Reconciliation Act of 2010, but most of it comes from the Patient Protection and Affordable Care Act of 2010.
PPACA Section 1332 already offers states a provision they can use to ask the U.S. Health and Human Services secretary for waivers from the usual Affordable Care Act rules.
Under the administration of former President Barack Obama, HHS secretaries required any state asking for a waiver to keep Affordable Care Act consumer protection rules, such as the ban on medical underwriting, in place.
HHS Secretary Tom Price has already announced that he will try to interpret the existing waiver provision flexibly.
Better Care Draft Section 206 Waiver Proposal
Better Care draft Section 206 would let a state go beyond the Obama administration waiver program limits.
A state could ask to waive the health insurance requirements described in PPACA Section 1332(a)(2), if the state came up with another way to increase access to comprehensive coverage, reduce average premiums and increase enrollment.
The Better Care draft does not actually list the requirements PPACA in Section 1332(a)(2) that a state could ask to waive.
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PPACA Section 1332(a)(2) itself refers to six major sections of the Affordable Care Act.
The sections listed in PPACA Section 1332(a)(2) include the rules for running the Affordable Care Act public exchange program; the rules for deciding which people qualify for exchange plan premium tax credit subsidies; the rules for policing the activities of public exchange program managers and exchange plan issuers; and the requirements for the "essential health benefits" package, or standard benefits package used in many Affordable Care Act programs and calculations.
It's not clear from the Better Care draft what kinds of standards an HHS secretary could use to determine whether a state had developed a reasonable alternative to the Affordable Care Act requirements.
