Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Data Insights

    The second part in this ACEs infographic series, this infographic explores the challenges facing children and families and provides actionable guidance to nurture resilience and support caregivers and parents.

    Part 1 Part 2
  • Data Insights

    The COVID-19 pandemic has placed a spotlight on the link between systemic racism and health in many communities. This new NIHCM infographic clarifies the relationship between long-standing social and economic inequities and health disparities affecting Black Americans, over the life course and in relation to COVID-19.

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  • Data Insights

    Globally, outdoor air pollution is attributed to 4.2 million deaths every year. This infographic explores air pollution in America and the unequal impact it has on Black and Latinx communities. It also looks at the current solutions that are already available to improve air quality.

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  • Awards

    We are honored to announce the winners for the 26th Annual Health Care Research and Journalism Awards. This year’s awards are virtual because of the COVID-19 pandemic, yet we invite you to meet the winners and learn about their award-winning work. NIHCM is also announcing the largest grant program in our history — $1 million to support work in journalism and research.

    Meet the Winners Press Release
  • Data Insights

    This infographic highlights the health challenges faced by the homeless community and outlines short and long term solutions to improve the health and well-being of these individuals, through social, economic and housing interventions.

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  • Data Insights

    This new Data Insights highlights the rapid rise in overdose deaths involving cocaine and methamphetamine, illustrates the geographic variations in utilization and death rates, and quantifies the increasing burden that these drugs are placing on the hospital system.

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Events

September 23, 2020
Latino Graphic

This webinar highlighted how systemic racism, the challenges of immigration, language barriers and other factors harm the health and well-being of Latinos.

September 10, 2020
Protecting Our Children

This webinar brought together experts to provide insight on early childhood development, ACEs and COVID-19’s impact on children.

In the News

September 2020
Population Health Spotlight
september-newsletter 8

The ACA's Section 1332 Waivers: Will We See More State Innovation in Health Care Reform?

Joel Ario, JD, Managing Director, Manatt Health

While the Affordable Care Act continues to be politically polarizing, my experience with stakeholders from across the health reform landscape is that they are focused on effectively implementing the law and on making incremental – not radical – changes to it. The question is how such change might happen given the deep national divisions about what corrections are needed. One answer lies in Section 1332 of the ACA, which invites states to be “laboratories of democracy” in experimenting with ACA reforms that do not have enough support to pass Congress but could garner backing at a state level.

Joel Ario
Joel Ario
What Could States Do?

Section 1332 authorizes states to request five-year renewable waivers from the U.S. Departments of Health and Human Services (HHS) and the Treasury to modify four pillars of the ACA, with changes beginning as early as 2017. First, states may modify the rules governing covered benefits, premium tax credits and cost-sharing subsidies. Second, they may replace or modify their ACA Marketplaces by providing health plan choice, subsidy eligibility determination, and enrollment in other ways. Finally, states may modify or even eliminate the ACA’s individual and/or employer mandates.

In designing new approaches, states must satisfy four statutory “guardrails” by providing coverage that is at least as (1) comprehensive and (2) affordable to (3) at least as many residents as would have been covered without the waiver, all (4) without increasing the federal deficit. Substantive guidance on how reform proposals will be judged against these guardrails, released in late 2015, was decidedly more restrictive than some states had hoped. Among the significant limitations was the requirement to consider coverage and affordability impacts in each waiver year separately, as well as for population subgroups such as the poor, elderly and chronically ill. The guidance also bars states from using savings generated through a separate Medicaid expansion waiver to offset costs in a 1332 waiver. Finally, states wishing to use different rules for Marketplace functions or subsidies will have to make all necessary operational arrangements themselves rather than rely on HHS and the Department of the Treasury.

What Are States Doing So Far?

These limitations have largely discouraged states from proposing sweeping reforms. To date, only three states have published draft waivers, and each was narrowly drawn to resolve unique issues that put the state at odds with certain ACA provisions. The first phase of a Massachusetts proposal to maintain certain rating practices in its merged small group and individual market was approved by HHS on other grounds, obviating the need to file its 1332 waiver this year.1 Similarly, Vermont’s draft waiver to continue relying on direct enrollment through carriers rather than building a Small Business Health Options Program (SHOP) portal was rendered moot by new HHS guidance delaying the mandatory change to an online portal until 2019.2 That leaves only Hawaii, which has formally asked to maintain its 40-year-old employer mandate rather than implement a SHOP that would offer less generous coverage and potentially decrease employer-based coverage. Hawaii’s unique situation may make its waiver the only one to gain approval in 2016.

Two other states have recently passed legislation to pursue 1332 waivers. California hopes to allow undocumented immigrants to purchase Marketplace policies without subsidies,3 and Alaska is interested in using its state-funded reinsurance program to reduce Marketplace premiums.

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Events

September 23, 2020
Latino Graphic

This webinar highlighted how systemic racism, the challenges of immigration, language barriers and other factors harm the health and well-being of Latinos.

September 10, 2020
Protecting Our Children

This webinar brought together experts to provide insight on early childhood development, ACEs and COVID-19’s impact on children.

In the News

September 2020
Population Health Spotlight
september-newsletter 8

Grants

Journalism GrantsJournalism Grant Program

The deadline for the 2020-2021 round of grant making has passed. NIHCM will notify the grant winners in the fall.

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NYTUpshotLogo

Investigator-Initiated Research Grant Program

The deadline for the 2020-2021 round of grant making has passed. Finalists have been notified.

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Awards

The 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

We are honored to announce the winners for the 26th Annual Health Care Research and Journalism Awards.

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