Will 'blue' states be forced to seek waivers under AHCA?

The American Health Care Act (AHCA) as approved last week by the House would sharply reduce federal subsidies designed to help lower-income Americans afford health insurance, which would put financial pressure on states that have been relying on this money to fund subsidies.

But the law also offers states opportunities to seek waivers exempting them from requirements. And while conservative (or “red”) states “are sure to be interested in rolling back the law's coverage requirements and freeing insurers to charge people more when they have preexisting conditions,” Kaiser Health News writes, “heavily Democratic states supportive of Obamacare, including California and New York, may be forced to do the same, according to experts, regulators and consumer advocates.”

That’s because no matter how much support a program has in even the most liberal (or “blue”) state, the money has to be there to run it. In addition, states will be under pressure both to keep insurers in their markets and prevent premium hikes that would price insurance beyond what most consumers could pay.

"Certainly the Californias and New Yorks of the world will do what they can to hold onto the ACA protections,” Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms, tells Kaiser. “But when confronted with insurer exits and big price hikes, many states with the best of intentions may feel they have little choice but to get a waiver."

These are among the issues members of the Senate must confront as they analyze the ACHA bill sent to them by the House. The Republicans hold only a slim majority (52 to 48) in the Senate, and several GOP senators have been critical of the legislation passed by the House. They will be under pressure to ensure that thousands or even millions of constituents don’t lose health coverage because it’s unaffordable or because they have a preexisting condition.

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