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.
  • Data Insights

    Mental illness is increasingly common among young people but many are not receiving the treatment that they need. This Data Insights explores current trends in youth mental health and opportunities to improve outcomes.

    Learn More
  • Grants

    NIHCM Foundation has awarded 14 grants for health care journalism including investigative reporting and educational opportunities for reporters.

    Press Release All Journalism Grantees
  • Awards

    NIHCM Foundation is pleased to welcome Dr. Karen DeSalvo, Dr. Aaron E. Carroll and Eliza Barclay to the independent judges panel of the NIHCM Awards. All three bring considerable expertise to the prestigious panel.

    Press Release Judges Panels The NIHCM Awards
  • Grants

    NIHCM Foundation has awarded over $500,000 in grants to support nine investigator-initiated research studies.

    Press Release All Research Grantees
  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

    Press Release Watch the Video
  • 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
  • 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.

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Events

February 24, 2020
Teen-Mental-Health-webinar-graphic

This webinar explored cross-sector strategies to prevent teen substance and suicide, as well as the role of school-based health services in providing behavioral health care.

January 27, 2020
SDOH-webinar-graphic-012720

This webinar explored public and private sector efforts to improve health outcomes by addressing social determinants of health.

In the News

February 2020
Population Health Spotlight
newsletter-alcohol-deaths-v2

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.

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Events

February 24, 2020
Teen-Mental-Health-webinar-graphic

This webinar explored cross-sector strategies to prevent teen substance and suicide, as well as the role of school-based health services in providing behavioral health care.

January 27, 2020
SDOH-webinar-graphic-012720

This webinar explored public and private sector efforts to improve health outcomes by addressing social determinants of health.

In the News

February 2020
Population Health Spotlight
newsletter-alcohol-deaths-v2

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.

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Investigator-Initiated Research Grant Program

Nine new grantees for the 2019-2020 funding cycle have been announced! We will begin accepting Letters of Inquiry for the 2020-2021 funding cycle in late spring 2020.

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Awards

Now Accepting Entries for the 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

Submit your research or reporting published in 2019 by February 3, 2020 for a chance to win up to $20,000. Winners and finalists will be recognized at a dinner in Washington, D.C., in May 2020.

Learn More and Apply