Health Access CA Discussion Paper: Options and Opportunities for California under Section 1332 of the ACA

Covered California is collaborating with the California Department of Health Care Services to explore options for California under Section 1332 of the Affordable Care Act (see Covered CA’s slide deck from last month’s informational webinar). Under Section 1332, states may seek a waiver from the federal government to pursue innovative approaches to achieve the primary goals of the ACA. The proposal should cover at least the same number of people with the same level of benefits, affordability, and consumer protections and cannot increase the federal deficit. Depending on local priorities for reform, states can seek to waive ACA provisions related to:

  • The Exchange marketplace and subsidies for coverage
  • Some insurance market rules but not all
  • The individual mandate
  • The employer responsibility requirement

California has taken important steps to not just implement but improve upon the ACA and a 1332 waiver is a new tool to take additional steps. Health Access is pleased to release a new discussion paper exploring the following broad areas of reform where a 1332 waiver could facilitate potentially worthwhile changes for California:

  • Inclusivity: Allowing undocumented Californians to buy unsubsidized plans through Covered CA.
  • Streamlined enrollment and reduced churn and disruption for consumers by aligning coverage and other rules between programs, especially Covered California and Medi-Cal.
  • Improved affordability: from premiums to cost-sharing to better benefits.
  • Broader system transformations such as a revamped employer mandate requirement or single-payer health care are theoretically possible through a 1332 waiver but face the same political and practical obstacles that previously existed.

Click here to read the paper. Since this is a discussion paper, we welcome your comments and questions. Please email to share your thoughts.


Covered CA and DHCS are hosting a panel discussion (also featuring Health Access’ Anthony Wright) on Section 1332 waiver options for California on February 23, 2016 8:30 AM to 12:30 PM at Covered CA: 1601 Exposition Blvd. Sacramento, CA 95815.

Click here for details (and to register for the webinar).