The Obama administration has said that states have significant flexibility in implementing ACA , from how they design exchanges to cracking down on insurance company abuses. States also have new resources to improve and lower costs in their Medicaid programs. For example, if states choose to operate their own exchange, they are eligible for grants to help design them and determine the rules, including whether to allow all companies to offer insurance in the exchange or to select only plans that improve the quality and affordability of the choices.
States could also provide tax credits that link small business tax credits to the tax credits for moderate-income families. Or they could change the benefit levels or add new benefit levels for health plans offered in the exchanges, HHS said in a media release.
The proposed regulation describes the content of the waiver application and how such proposals may be disclosed to the public, monitored, and evaluated. The Obama administration said it wants suggestions for improving this process from states, patients, providers, and the public.