Sep 11, 2017

What the Senate has in mind for the ACA's "innovation waivers"

Sen. Lamar Alexander talks to governors about the ACA. (AP Photo/Jose Luis Magana)

The Senate HELP Committee this week is scheduled to resume its hearings on stabilizing the Affordable Care Act, and it's already clear Chairman Lamar Alexander wants that effort to focus on the process by which states can obtain what are known as "innovation waivers."

How it works: States can already seek a waiver from many of the ACA's mandates, including the one that requires insurance plans to cover certain "essential" benefits. But, to get a waiver, they have to prove that their new plan would cover just as many people, with plans that are just as generous, without increasing federal spending.

  • "States actually have a lot flexibility in theory under current waivers, but the guardrails are very hard to meet, which limits the amount of flexibility in practice," the Kaiser Family Foundation's Larry Levitt told me.

What could change:

  • During the repeal-and-replace effort, Republicans wanted to remove some of those "guardrails" — allowing states to chip away more substantively at some of the law's benefit mandates and coverage guarantees.
  • Alexander, though, is trying to keep his proposal more tailored. He's focusing more on changes to the process of seeking a waiver than on the substance of what can be waived.
  • For example, he's talked about letting states essentially copy each other's applications, and letting governors submit an application without clearance from their legislatures.

Will it work? The problem with expanded waivers, last time, was that the ACA is so interconnected, rolling back one part of the law can quickly implicate another, more politically sensitive part. Could Alexander run into the same issue just with process changes? And will process changes alone make any difference in premiums, which is the whole point here?

  • "If you make waivers a lot easier to get from a process standpoint, the substantive rules could matter less because the federal government may have less ability to enforce them," Levitt said. "In that sense, relaxing the process could make a big difference."

Go deeper

World coronavirus updates

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

Countries where novel coronavirus cases are falling may be hit with a "second peak" if they relax restrictions too soon, World Health Organization emergencies chief Mike Ryan warned during a briefing Monday. "We're still very much in a phase where the disease is actually on the way up," he added.

By the numbers: Almost 5.5 million people have tested positive for the virus as of Monday, and more than 2.2 million have recovered. The U.S. has reported the most cases in the world (over 1.6 million from 14.6 million tests). The U.K. is reporting over 36,900 deaths from the coronavirus — the most fatalities outside the U.S.

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 3 a.m. ET: 5,498,849 — Total deaths: 346,306 — Total recoveries — 2,233,180Map.
  2. U.S.: Total confirmed cases as of 3 a.m. ET: 1,662,768 — Total deaths: 98,223 — Total recoveries: 379,157 — Total tested: 14,604,942Map.
  3. World: Italy reports lowest number of new cases since February — Ireland reports no new coronavirus deaths on Monday for the first time since March 21 — WHO suspends trial of hydroxychloroquine over safety concerns.
  4. 2020: Trump threatens to move Republican convention from North Carolina — Joe Biden makes first public appearance in two months.
  5. Public health: Officials are urging Americans to wear masks over Memorial Day.
  6. Economy: New York stock exchange to reopen its floor on Tuesday — White House economic adviser Kevin Hassett says it's possible the unemployment rate could still be in double digits by November's election — Charities refocus their efforts to fill gaps left by government.
  7. What should I do? Hydroxychloroquine questions answeredTraveling, asthma, dishes, disinfectants and being contagiousMasks, lending books and self-isolatingExercise, laundry, what counts as soap — Pets, moving and personal healthAnswers about the virus from Axios expertsWhat to know about social distancingHow to minimize your risk.
  8. Other resources: CDC on how to avoid the virus, what to do if you get it, the right mask to wear.

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Updated 2 hours ago - Politics & Policy

LATAM Airlines files for U.S. chapter 11 bankruptcy

A LATAM air attendant aboard one of the company's planes in March. Photo: Kike Calvo/Universal Images Group via Getty Images

LATAM Airlines Group SA said in a statement early Tuesday the firm and its affiliates in in the United States, Chile, Peru, Colombia and Ecuador have filed for Chapter 11 bankruptcy protection in the U.S.

Why it matters: Latam is Latin America's largest airline and its shareholders include Delta Air Lines. CEO Roberto Alvo noted in the statement the coronavirus pandemic has had a huge impact on the airline industry.