1332

States utilize 1332 waivers to address specific local market challenges:

The proposal cannot increase the federal deficit. Key Strategic Uses & Examples States utilize 1332 waivers to address specific local

This report focuses on the program, a critical component of the Patient Protection and Affordable Care Act (ACA) that enables states to customize their health insurance markets. Executive Summary: Section 1332 Waivers Approved states often use these waivers to establish

Section 1332 waivers permit states to bypass specific ACA requirements—such as the individual mandate, employer mandate, or certain exchange standards—to implement innovative strategies that improve health insurance affordability, accessibility, and coverage. Approved states often use these waivers to establish or expand coverage to residents regardless of income (e.g., New York’s 2024 expansion ). Core Requirements (Guardrails) The plan must provide cost-sharing protections equal to

Coverage must be as robust as ACA marketplace plans.

Many states (e.g., Alaska, Minnesota, Oregon ) use waivers to fund reinsurance, which compensates insurers for high-cost enrollees, successfully lowering premiums in the individual market.

The plan must provide cost-sharing protections equal to or better than the ACA.