Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Infographics

    Since 2000, the opioid crisis has both grown in magnitude and changed in character. This new series of interactive data visualizations depicts these evolving trends.

    Learn More
  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • Awards

    NIHCM Foundation hosted the 25th Annual NIHCM Awards at the Organization of American States in Washington, D.C. to recognize outstanding health care research and journalism.

    Press Release Winners Finalists
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

  • Webinars

    As recognition of our country's mental and behavioral health challenges grows, Americans are looking for answers that will increase their happiness and well-being and prevent deaths of despair related to mental health, opioids and suicide. Our four-part webinar series delves into the research and explores innovative strategies and evidence-based solutions to lift our society from crisis.

    Learn More
  • Grants

    NIHCM Foundation has awarded ten grants for health care journalism including investigative reporting, public engagement campaigns for documentaries and educational opportunities for reporters.

    Press Release All Journalism Grantees Apply for Funding
  • Grants

    NIHCM has awarded over $400,000 in grants to support seven investigator-initiated research studies on topics including value-based drug pricing and Medicaid expansion.

    Press Release All Research Grantees Apply for Funding
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7

Events

August 29, 2019
Early-Childhood-Webinar-Graphic

This webinar explored how high-quality early childhood education (ECE) has an enormous positive impact on lifelong health, serving as a protective factor against adult disease and disability.

August 28, 2019
Allliance-Webinar-Aug2019

During this webinar, experts shared their thoughts on what health care policy activity might be expected before the end of 2019.

In the News

September 2019
Population Health Spotlight
in-the-news 2

The ACA's Section 1332 Waivers: Will We See More State Innovation in Health Care Reform?

Joel Ario, JD, Managing Director, Manatt Health

While the Affordable Care Act continues to be politically polarizing, my experience with stakeholders from across the health reform landscape is that they are focused on effectively implementing the law and on making incremental – not radical – changes to it. The question is how such change might happen given the deep national divisions about what corrections are needed. One answer lies in Section 1332 of the ACA, which invites states to be “laboratories of democracy” in experimenting with ACA reforms that do not have enough support to pass Congress but could garner backing at a state level.

Joel Ario
Joel Ario
What Could States Do?

Section 1332 authorizes states to request five-year renewable waivers from the U.S. Departments of Health and Human Services (HHS) and the Treasury to modify four pillars of the ACA, with changes beginning as early as 2017. First, states may modify the rules governing covered benefits, premium tax credits and cost-sharing subsidies. Second, they may replace or modify their ACA Marketplaces by providing health plan choice, subsidy eligibility determination, and enrollment in other ways. Finally, states may modify or even eliminate the ACA’s individual and/or employer mandates.

In designing new approaches, states must satisfy four statutory “guardrails” by providing coverage that is at least as (1) comprehensive and (2) affordable to (3) at least as many residents as would have been covered without the waiver, all (4) without increasing the federal deficit. Substantive guidance on how reform proposals will be judged against these guardrails, released in late 2015, was decidedly more restrictive than some states had hoped. Among the significant limitations was the requirement to consider coverage and affordability impacts in each waiver year separately, as well as for population subgroups such as the poor, elderly and chronically ill. The guidance also bars states from using savings generated through a separate Medicaid expansion waiver to offset costs in a 1332 waiver. Finally, states wishing to use different rules for Marketplace functions or subsidies will have to make all necessary operational arrangements themselves rather than rely on HHS and the Department of the Treasury.

What Are States Doing So Far?

These limitations have largely discouraged states from proposing sweeping reforms. To date, only three states have published draft waivers, and each was narrowly drawn to resolve unique issues that put the state at odds with certain ACA provisions. The first phase of a Massachusetts proposal to maintain certain rating practices in its merged small group and individual market was approved by HHS on other grounds, obviating the need to file its 1332 waiver this year.1 Similarly, Vermont’s draft waiver to continue relying on direct enrollment through carriers rather than building a Small Business Health Options Program (SHOP) portal was rendered moot by new HHS guidance delaying the mandatory change to an online portal until 2019.2 That leaves only Hawaii, which has formally asked to maintain its 40-year-old employer mandate rather than implement a SHOP that would offer less generous coverage and potentially decrease employer-based coverage. Hawaii’s unique situation may make its waiver the only one to gain approval in 2016.

Two other states have recently passed legislation to pursue 1332 waivers. California hopes to allow undocumented immigrants to purchase Marketplace policies without subsidies,3 and Alaska is interested in using its state-funded reinsurance program to reduce Marketplace premiums.

Prev
1 |
2 |

Events

August 29, 2019
Early-Childhood-Webinar-Graphic

This webinar explored how high-quality early childhood education (ECE) has an enormous positive impact on lifelong health, serving as a protective factor against adult disease and disability.

August 28, 2019
Allliance-Webinar-Aug2019

During this webinar, experts shared their thoughts on what health care policy activity might be expected before the end of 2019.

In the News

September 2019
Population Health Spotlight
in-the-news 2

Grants

Journalism GrantsJournalism Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. NIHCM will notify grant winners in November 2019.

Read More


NYTUpshotLogo

Investigator-Initiated Research Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. A small number of applicants will be invited to submit a full proposal in September.

Read More

Awards

Winners Named in the 25th Annual Research and Journalism Awards

Winners Announcment 2018 1

Congratulations to all of the winners of the 25th Annual NIHCM Foundation Research and Journalism Awards! The winners and finalists were honored at a banquet in Washington, DC, in May.

Read More