Policy & Research


Issue Brief: An Alternative Path to State-Specific Health Reform

Exploring the ACA's Section 1332 Waiver

By , Linda J. Sheppard, J.D. | January 26, 2016

Issue Brief: An Alternative Path to State-Specific Health Reform

For Kansas and other states that have been opposed to the content and philosophy of the Affordable Care Act (ACA), a section of the law provides an opportunity to opt out of some of its key requirements beginning in 2017.  

Section 1332 of the ACA allows states to apply for a waiver to implement alternative strategies to providing citizens with access to affordable health care.

The Kansas Health Institute (KHI) has released a new issue brief, entitled An Alternative Path to State-Specific Health Reform: Exploring the ACA's Section 1332 Waiver, that explains the waiver requirements and application process as well as some of the benefits and challenges of seeking a waiver.

Key points include:     

  • Section 1332 of the Affordable Care Act (ACA) allows individual states to develop their own approaches to health reform.
  • A state's waiver application must show its plan will meet the comprehensive coverage, affordability, coverage for comparable number of residents, and budget neutrality requirements.
  • States that receive waivers may become eligible for federal dollars to help implement their waiver plans.
  • While no state has submitted a waiver application yet, at least eight states are considering doing so: Arkansas, California, Hawaii, Massachusetts, Minnesota, New Mexico, Rhode Island and Vermont.

According to Linda J. Sheppard, J.D., Senior Analyst & Strategy Team Leader at KHI and one of the authors of the brief, “The challenges of applying for a Section 1332 waiver may be well worth the effort if it allows states to implement health care and coverage systems that contribute to the long-term health of their citizens.”

The Kansas Health Institute (KHI) delivers objective information, conducts credible research, and supports civil dialogue enabling policy leaders to make informed health policy decisions that enhance their effectiveness as champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.