University of Utah.
Ohio University.
J Health Polit Policy Law. 2024 Apr 1;49(2):269-288. doi: 10.1215/03616878-10989687.
Section 1332 of the Affordable Care Act (ACA) provides states unprecedented flexibility to alter federal health policy. The authors analyze state waiver activity from 2019 to 2023, applying a comparative approach to understand waivers proposed by Georgia, Colorado, Washington, Oregon, and Nevada. Much of the waiver activity during this period focused on reinsurance programs. During the Trump administration, the most innovative waiver application was from Georgia, which sought to restructure and decentralize its individual market, moving away from the framework established by the ACA. While the Biden administration suspended Georgia's efforts, Democratic-led states have focused implementing waiver programs supporting and expanding on the ACA. This has included adopting public-option insurance plans offered by private insurers and expanding eligibility for qualified health plans for previously ineligible groups. The authors' analysis offers insights into contemporary health politics, policy durability, and the role of the administrative presidency.
《平价医疗法案》（ACA）第 1332 条赋予各州改变联邦医疗政策的前所未有的灵活性。作者分析了 2019 年至 2023 年期间各州的豁免活动，采用比较方法来理解佐治亚州、科罗拉多州、华盛顿州、俄勒冈州和内华达州提出的豁免。这一时期的大部分豁免活动都集中在再保险计划上。在特朗普政府时期，最具创新性的豁免申请来自佐治亚州，该州试图重组和分散其个人市场，摆脱 ACA 建立的框架。尽管拜登政府暂停了佐治亚州的努力，但民主党领导的州已专注于实施支持和扩大 ACA 的豁免计划。这包括采用私人保险公司提供的公共选择保险计划，并扩大以前不符合条件的群体获得合格健康计划的资格。作者的分析提供了对当代健康政治、政策耐久性以及行政总统角色的深入了解。
