Big Waiver Under Statutory Sabotage

Social Solidarity in Health Care, American-Style

“…Other key features of the ACA intentionally deferred to state authority in the process of national reform, 44 diluting the statute’s universal coverage strategy. Reliance on state implementation of the exchanges and the provision of a waiver for states to deviate from certain national protections in the name of “State Innovation” serve as two prominent examples, 45 while the resort to state definitions for federal essential health benefits represents another. 46 Political bargains struck in the spirit of voluntary deference to the states have spurred opportunistic variations in policy and exacerbated some interstate disparities, 47 offsetting gains in health equity produced by more durable federal baselines.…”