December 6, 2018

CMS Proposes to Enable States to Forge Their Own Paths on Health Care

Last Thursday, the Centers for Medicare and Medicaid Services (CMS) greeted World AIDS Day by announcing a plan that, according to the Washington Post, could “allow the [federal] subsidies to be used for health plans the administration has been promoting outside the ACA marketplaces that are less expensive because they provide skimpier benefits and fewer consumer protections.”

CMS purports to be doing this to “give states more flexibility in forging their own path on health care”. Section 1332 of the Affordable Care Act (ACA) already allows states to submit a State Innovation Waiver to “pursue innovative strategies…for providing access to high quality, affordable health insurance while retaining the basic protections of the ACA.”

CMS has just renamed this mechanism as the “State Relief and Empowerment Waiver”. CMS Director Seema Verma asserted in a speech to ALIC (the American Legislative Exchange Council) that, “Seeing the problems the ACA created, and seeing the lack of federal action to address these problems, should be proof enough for why it was such a mistake to federalize so much of health-care policy under the ACA.”

According to the New York Times, however, Seema would prefer to see waivers that would allow states to, “develop a new state premium subsidy structure and decide how premium subsidies should be targeted”. She added that states should be able to “set the rules for what type of health plan is eligible for state premium subsidies.”

Sarah Lueck, a senior analyst at the Center on Budget and Policy Priorities, described these proposals to the Washington Post as reminiscent of last year’s ACA “repeal and replace” debate in Congress, adding that CMS’ proposal could enable states to “pursue policies that could reduce subsidies available for vulnerable populations, offer inadequate coverage options or leave people with unaffordable coverage.”  Senator Patty Murray (D-WA) said that, if implemented, these waivers would be “nothing more than a how-to guide for health care for health care sabotage.”

Ending the HIV Epidemic in the United States: A Roadmap for Federal Action 

On World AIDS Day, the Act Now: End AIDS coalition (ANEA – a national coalition of HIV service organizations, providers, and people living with HIV) publicly unveiled a policy paper calling on the federal government to officially commit itself to ending the HIV epidemic in the United States by 2025[1]. It further demands that the government act on this commitment by enacting legislative and regulatory changes to achieve this goal.

The Academy participates in the coalition and is one of the 250 national, regional, state, local, and global organizations endorsing the plan. The idea for this project arose last March when Dr. Robert Redfield, the newly appointed Director of CDC, said that “the AIDS epidemic in the United States could be ended in the next few years…in the next three to seven years if we put our minds to it.” Redfield raised the topic publicly again in September but a firm timeline or commitments to this goal have not been forthcoming.

Redfield’s repeated assertions inspired HIV/AIDS advocates and service providers to consider what a national roadmap for meeting this challenge might actually look like. Ten states and the District of Columbia are already implementing state-wide plans to end HIV/AIDS, complete with firm timelines and objective progress measures. The thought of creating such a plan for the entire US (including its six dependent areas) became an important step forward to Act Now: End AIDS because, clearly, the goal cannot be accomplished without decisive action from Congress and the Administration. The signers of the document, therefore, “call on the US Government to officially declare that it is our [collective] goal to end the HIV epidemic in the US by 2010 and to enact legislative and regulatory changes to achieve this goal.

The Academy participated in this project primarily by soliciting and contributing information from our members regarding the urgent needs of health care providers serving people living with HIV and those highly vulnerable to HIV. Several of the points our members contributed now appear in the Roadmap.

The report can be downloaded at  Members’ feedback is welcome.

[1] One definition of ending the epidemic is “bending the curve” of new infections so that it is going down rather that rising or remaining flat.

View the latest Policy Update here.