October 29, 2019

Democrats Try to Curb Health Care Coverage


  • Senate Democrats introduced a Congressional Review Act resolution to overturn President Trump’s guidance giving states more flexibility to offer affordable health insurance options.
  • The guidance on waivers under section 1332 of Obamacare maintains protections for people with pre-existing conditions and allows states to experiment with coverage options tailored to their residents’ needs. 
  • The Trump administration’s guidance rightfully prioritizes consumer choice and access. 

Senate Democrats have introduced a Congressional Review Act resolution to rescind President Trump’s guidance allowing states relief from some of Obamacare’s restrictions. The new guidance makes it easier for states to get waivers so they can give their residents better access to affordable health insurance.


Obamacare required states to guarantee that their insurance exchanges offered comprehensive coverage that met numerous requirements. As a result of all the mandates, premiums increased by more than 100% from 2013 to 2017 in states using the Healthcare.gov marketplace.

Section 1332 of the health care law allowed states to get waivers exempting them from some of the requirements and create state-based reforms. However, the Obama administration had strict rules limiting the use of these waivers. In July 2018, 14 state governors asked for changes to allow them to lower costs and properly provide coverage to their residents. The Trump administration responded last October by rescinding the Obama administration’s 1332 rules and providing new guidance that gives states greater flexibility. 

The guidance expanded what could be considered insurance “coverage” under the law, allowing more types of plans, such as catastrophic or short-term limited-duration insurance. The Trump administration’s standard allows people enrolled in these less comprehensive, more affordable plans to be counted toward the coverage requirement. The state must ensure that people who remain in the individual market have access to coverage that is as affordable and comprehensive as it was before the waiver. The guidance also maintains requirements to protect people with pre-existing conditions.

CRA 1332

The goal of the guidance is to allow states to look for ways to improve their health insurance markets. Patients gain new options for coverage that better suits their needs and their budgets. People who want to keep their Obamacare plan still can. However, if they find the plan does not meet their health care needs, they have other options and can decide which coverage is best for them and their families.

Prioritizing Choice and Access

Waivers have contributed to lower health insurance premiums. Average premiums for a benchmark silver plan in seven states that received waivers – Alaska, Maine, Maryland, Minnesota, New Jersey, Oregon, and Wisconsin – decreased by 7.5% from 2018 to 2019. In the rest of the states, the rates increased by 3%.

Another five states have received waivers from the Trump administration for next year: Colorado, Delaware, Montana, North Dakota, and Rhode Island. These states estimate premiums will decline next year by anywhere from 6% in Rhode Island to 20% in North Dakota.

Congressional Democrats are seeking to stop these premium cuts and maintain the failing Obamacare markets at any cost. Their latest attempt is to use a resolution under the Congressional Review Act to overrule the guidance on 1332 waivers. In July the Government Accountability Office deemed the guidance to be subject to congressional review; the resolution could be voted on in early September. If it passes with a majority vote, it would halt states’ success with 1332 waivers and leave them once again with limited tools to manage their health care budgets and protect their residents.

Issue Tag: Health Care