State Health Care Reform: Waivers, Single-Payer, and the Need for Alternative Pathways
Authors: James Maroulis, Tim Ken Mackey
Journal: Annals of Internal Medicine (2019)

Ideas and Opinions20 August 2019State Health Care Reform: Waivers, Single-Payer, and the Need for Alternative PathwaysJames Maroulis, JD, MAS and Tim Ken Mackey, MAS, PhDJames Maroulis, JD, MASUniversity of California San Diego, San Diego, California (J.M.)Search for more papers by this author and Tim Ken Mackey, MAS, PhDGlobal Health Policy Institute and University of California, San Diego School of Medicine, San Diego, California (T.K.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0509 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The U.S. health care system is in transition. Politicians, interest groups, and constituents disagree about how to change coverage, reduce costs, regulate health care markets, and navigate the future of health care reform after the Patient Protection and Affordable Care Act (ACA). Meanwhile, the number of uninsured adults has increased by 7 million since late 2016, and this number does not include the millions of Americans who remain underinsured (1).States have the power to regulate health insurance, medical benefits, providers, and other aspects of health care delivery, and they have started exploring reform measures to fill coverage gaps. However, ...References1. Witters D. U.S. uninsured rate rises to four-year high. 23 January 2019. Accessed at https://news.gallup.com/poll/246134/uninsured-rate-rises-four-year-high.aspx on 10 May 2019. Google Scholar2. Tolbert J, Pollitz K. New rules for section 1332 waivers: changes and implications. 10 December 2018. Accessed at www.kff.org/health-reform/issue-brief/new-rules-for-section-1332-waivers-changes-and-implications/ on 1 May 2019. Google Scholar3. Service Members Home Ownership Tax Act of 2009. Congressional Record. 2009;155:S13853. Google Scholar4. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Medicare waiver demonstration application. Accessed at https://innovation.cms.gov/Files/x/MedicareAppWaiver.pdf on 1 May 2019. Google Scholar5. Rosenbaum S. The Trump administration re-imagines section 1115 Medicaid demonstrations – and Medicaid. Health Affairs Blog. 9 November 2017. Accessed at www.healthaffairs.org/do/10.1377/hblog20171109.297738/full/ on 5 May 2019. Google Scholar6. Schneider A. Judge blocks Arkansas and Kentucky Medicaid work requirement waivers: what does this decision mean for other states? 28 March 2019. Accessed at https://ccf.georgetown.edu/2019/03/28/judge-blocks-arkansas-and-kentucky-medicaid-work-requirement-waivers/ on 4 May 2019. Google Scholar7. Manatt Health. Understanding the rules: federal legal considerations for state-based approaches to expand coverage in California. February 2018. Accessed at www.manatt.com/getattachment/6c6ebd95-d8da-40be-9529-04cbbb7b8142/attachment.aspx on 2 May 2019. Google Scholar8. Kaiser Family Foundation. Medicaid waiver tracker: approved and pending section 1115 waivers by state. 18 April 2019. Accessed at www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/ on 1 May 2019. Google Scholar9. Centers for Medicare & Medicaid Services. FACT SHEET: Hawaii: state innovation waiver. 30 December 2016. Accessed at www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Downloads/Hawaii-1332-Waiver-Fact-Sheet-12-30-16-FINAL.pdf on 3 May 2019. Google Scholar10. Howard H. Map: state efforts to develop Medicaid buy-in programs. 13 May 2019. Accessed at www.shvs.org/state-efforts-to-develop-medicaid-buy-in-programs/ on 15 May 2019. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of California San Diego, San Diego, California (J.M.)Global Health Policy Institute and University of California, San Diego School of Medicine, San Diego, California (T.K.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0509.Corresponding Author: Tim Ken Mackey, MAS, PhD, Global Health Policy Institute, 8950 Villa La Jolla Drive, Suite A124, San Diego, CA 92037; e-mail, [email protected]edu.Current Author Addresses: Mr. Maroulis and Dr. Mackey: 8950 Villa La Jolla Drive, Suite A124, La Jolla, CA 92037.Author Contributions: Conception and design: J. Maroulis, T.K. Mackey.Analysis and interpretation of the data: J. Maroulis, T.K. Mackey.Drafting of the article: J. Maroulis, T.K. Mackey.Critical revision of the article for important intellectual content: J. Maroulis, T.K. Mackey.Final approval of the article: J. Maroulis, T.K. Mackey.Administrative, technical, or logistic support: J. Maroulis, T.K. Mackey.Collection and assembly of data: J. Maroulis, T.K. Mackey.This article was published at Annals.org on 23 July 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 20 August 2019Volume 171, Issue 4Page: 281-282KeywordsForecastingGlobal healthHealth careHealth care providersHealth care qualityHealth care sectorHealth insuranceMedicarePatient Protection and Affordable Care ActPopulation statistics ePublished: 23 July 2019 Issue Published: 20 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...