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Maine gets first state waiver from health care law

New 'Innovation Waiver' may give more power to states

Published: Thursday, March 10 2011 2:13 p.m. MST

The number of Affordable Care Act health care waivers took a giant leap forward this week, with more than a million individual waivers joining the 1,040 organization waivers that have currently been approved.

On Tuesday, Maine became the first state to obtain a waiver exempting it from a key provision to the 2010 health care reform law, thereby creating individual waivers for each of its citizens.

According to The Hill, the waiver would exempt the state from the laws requirement that it spend at least 80 percent of premiums on patient care. The Boston Globe reports that the waiver will allow Maine insurers to maintain its 65 percent standard for three years.

In Maine, Anthem Blue Cross Blue Shield of Maine, MEGA Life and Health Insurance Co. and HPHC Insurance Co. make up the bulk of the states individual insurance market, The Wall Street Journal reports.

The state applied for a waiver after Health Markets Inc. said that it would stop selling its MEGA Life policies, which are directed at people who buy plans without the help of an employer, if the state didnt get an exemption.

According to Bloomberg, the MEGA Life unit — which controls about 37 percent of Maines individual insurance coverage market — is being sued by Los Angeles for allegedly selling junk insurance.

However, Steve Larsen, an HHS deputy administrator, wrote that MEGAs departure from the market would carry the reasonable likelihood of destabilizing the Maine individual market, which is why the waiver was approved.

The Department of Health and Human Services states on its website that one-year waivers are being offered to companies — and states — in order to prevent either a large increase in premiums or a significant decrease in access to coverage.

HHS also reports that waivers issued thus far have been for employment-based coverage like collectively-bargained employer-based plan applicants and health reimbursement arrangements, health insurers and state governments. Companies with waivers include 24 Hour Fitness, American Eagle Outfitters, Big Lots Inc. and Waffle House. A full list of waiver recipients is available here.

According to the Center for Consumer Information and Insurance Oversight, waivers similar to Maine's are under review for New Hampshire, Nevada and Kentucky. States or plans covered under the state applications include Massachusetts, New Jersey, Ohio and Tennessee.

However, USA Today reports that Health and Human Services proposed a new "Innovation Waiver" Thursday to give states more freedom in developing their health care systems and policies.

Innovation Waivers empower states to take the lead on implementing the Affordable Care Act, said HHS Secretary Kathleen Sebelius in a news release. Todays announcement demonstrates the flexibility available to states as they continue to move forward on fixing our broken health insurance marketplace.

Business Insurance reports that the need for mini-med plans, which are the driving force behind waivers, would be reduced in 2014, when state insurance exchanges would create government-subsidized coverage for low-wage employees.

Waivers from the federal health care law have come under fire from conservatives and Republicans in the House. According to The Wall Street Journal, Rep. Darrell Issa, R-Calif., is pressing Sebelius for answers regarding what applicants havent received waivers and why.

According to The Hill, Republicans on both the House Energy and Commerce Committee and the House Committee on Oversight and Government Reform are also investigating the waiver process.

Additionally, The Hill reported Thursday that Rep. Mike Rogers, R-Mich., is pushing a bill that would allow all individuals to get a waiver from major provisions of the health care law.

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