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GAO-16-637R 1 (2016-07-06)

handle is hein.gao/gaobaakaj0001 and id is 1 raw text is: GAOU.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 July 6, 2016 The Honorable Orrin Hatch Chairman Committee on Finance United States Senate Patient Protection and Affordable Care Act: Information on Approval Process for State Innovation Waivers Dear Mr. Chairman: The Patient Protection and Affordable Care Act (PPACA) includes provisions intended to increase the number of Americans who have health coverage and outlines a shared role between states and the federal government for doing so.1 For example, PPACA required that individuals maintain health insurance coverage and required the establishment in every state of health insurance exchanges-also known as marketplaces-through which up to 11.4 million individuals are estimated to receive coverage in 2016.2 To allow for state innovation in providing their residents with access to health insurance while retaining the basic protections of PPACA, section 1332 of the statute permits states to seek federal approval to waive certain key requirements under the law (referred to as state innovation waivers or 1332 waivers).3 Under 1332 waivers, for example, states may seek approval to waive the requirements that individuals maintain health insurance coverage, that exchanges perform certain functions, and that benefits of plans offered through the exchanges meet certain standards. States may also seek approval to waive PPACA requirements governing federal subsidies to assist qualifying low-income individuals in affording coverage purchased through exchanges; these subsidies are estimated to total $45 billion in 2016. However, PPACA requires that state 1332 proposals meet four approval criteria. Specifically, a state proposal must demonstrate that the waiver will result in coverage that is at least as available, comprehensive, and affordable as would have existed without the waiver, and that the waiver will not increase the federal deficit. The Department of Health and Human Services (HHS) and the Department of Treasury (Treasury; hereafter referred to together as the Departments) are jointly responsible for 1Pub. L. No. 111-148, 124 Stat.119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. No. 111-152, 124 Stat. 1029 (2010). For the purposes of this report, references to PPACA include the amendments made by HCERA. 2The Department of Health and Human Services commonly refers to the exchanges as marketplaces. Where we discuss exchanges in this report, we are referring to the individual exchanges and the small business exchanges required under PPACA. For the Department's estimate on the number of individuals expected to receive coverage through the exchanges, see Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Issue Brief: How Many Individuals Might Have Coverage at the End of 2016? (Washington D.C.; October 2015). 3pub. L. No. 111-148, § 1332, 124 Stat. 119, 203-206 (2010) (codified at 42 U.S.C. § 18052). GAO-16-637R Affordable Care Act Waivers Page 1

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