Week in Washington: Maryland Joins Growing Ranks of Approved 1332 Waivers

August 23, 2018

Maryland became the 7th state to have its reinsurance based 1332 waiver approved. Maryland’s reinsurance program resulted in a dramatic reduction in premium increases. Wakely was part of the successful waiver application as it provided the economic and actuarial analysis that undergirded the application. A map of all the states with approved 1332 waivers can be found here.

A few additional pieces of news…

Individual Market

  • The GAO released a new report stating that cuts In outreach may have harmed enrollment. As further cuts are expected for the forthcoming benefit year, there could be further effects on enrollment.
  • New analysis by Axios highlights the profitability of ACA individual market plans. The combination of changes to tax laws and higher premiums were driving the profits.
  • CMS Administrator announced that the administration would work with Congress to protect pre-existing conditions if a ruling in the Texas v. US case overturns key portions of the ACA. The hearings for the case are scheduled for September 5th.


CMS released new guidance on 1115 waivers, strengthening the budget neutrality aspect of the waiver. The guidance lists a specific methodological formula that states should use to handle the budget neutrality test. States preparing for new 1115 waivers should consider the implications.


New analysis by Morgan Stanley projects that 8% of US private and public hospitals were at risk for closing and another 10% considered weak. The expectation by the analyst is over the next 12 to 18 months there would be an increase in hospital closings.

Prescription Drugs

A current fight in Congress over a spending bill centers on prescription drug disclosure. In particular, Senator Grassley and Durbin are asking for additional funding to enable HHS to disclose drug pricing information in consumer advertising. AHIP supports the proposal, which you can read here.