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 supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be 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.