The healthcare bill is a mess–it won’t cover all Americans at affordable costs and it will hand insurance companies tens of billions of dollars in new profits, the hard-earned wages of working people who are already stressed out financially.
The only ray of light down the road to fix this, if you just deal with the Senate language, is Section 1332. Here is Bernie Sanders’ explanation:
If the Senate bill is passed, the only opportunity that states would have to move towards a single payer system would be to get a waiver from the Exchange requirements through Section 1332.[1]
Section 1332 enables a state to apply for and receive a waiver (beginning in 2017) from the requirement to operate an Exchange. In order to get such a waiver, the state would have to present an alternative plan that would provide coverage at least as comprehensive and affordable, to at least a comparable number of residents, as the federal legislation would achieve. The state plan could not increase the federal deficit.
States could apply for Section 1332 waivers for up to 5 years at a time. To do so, they would have to comply with transparency regulations in the development of the state plan and enact a law providing for state action under the plan. If the state waivers were approved, the federal government would provide the State the aggregate amount of any tax credits and cost-sharing reductions that would have been paid to residents of the State in the absence of a waiver, which may only be used for providing health insurance coverage under the state plan.
Section 1332 does not expand existing waiver authority under any existing federal health program (e.g., Medicaid, Medicare, CHIP), but it would require the Secretary to create a coordinated waiver process so that a state could submit a single application for waivers under Sec. 1332 and under any other federal health law for which waiver authority already exists.
In order for states to try a different approach without first having to set up an Exchange, the date the waivers are currently available under Section 1332 of the Senate bill would have to be changed from 2017 to 2014. Otherwise, a state seeking to innovate using a different model – including something approaching a single payer system at the state level – would first have to go through all the trouble and expense of establishing and operating an Exchange before having the opportunity to receive a waiver.
Assuming the date in section 1332 is changed, however, this provision will facilitate state efforts to set up single payer systems. If a state plan to cover everyone through an alternative model is approved, they will not be required to set up an Exchange through which private companies compete. In other words, after receiving such a waiver, states would no longer be preempted from setting up their own systems in lieu of an Exchange.
Keep that in mind.
