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Former Jeb Bush health czar has a message for Florida Republicans: Get a waiver

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He advised former Florida Gov. Jeb Bush, Louisiana Gov. Bobby Jindal and the Republican Governors Association.

A go-to health care policy wonk for Republicans, Alan Levine now says he has a message for Florida Republicans in the Legislature: Tap into a 1332 innovation waiver under the Affordable Care Act. The waiver allows the state to essentially circumvent the employer mandate, the  individual mandates as well as provisions on exchanges and premium credits.

“If the Legislature wants to be bold and offer a conservative solution, it’s one of the best tools I’ve seen,”  Levine told Florida Politics via a series of Facebook messages. Levine, Mountain States Health Alliance President and Chief Executive Officer, works in Tennessee now but says he cares about what happens in his native state and will start talking to Republicans about the 1332 waiver option.

The section 1332 waiver would allow the state to circumvent most of the requirements of the Affordable Care Act and use the  federal funds that would have been funneled to Florida under Obamacare — such as the premium tax credits to individuals who enroll through healthcare.gov and tax credits for small businesses– to fund the state created program. Levine’s “read” of the section is that the state also would be authorized to use Medicaid dollars, federal Title XXI dollars (the Children’s Health Insurance Program) and Low Income Pool dollars to fund the state program.

Levine called section 1332 of Obamacare “the red carpet Republican governors have been wanting.”

“I’d have loved to have had this waiver authority when we did our waiver,” Levine said, referencing the initial five-year Medicaid 1115 waiver that he and his former boss, Gov. Jeb Bush secured in 2005. The waiver–which took effect in 2006–allows the state to operate a statewide Medicaid managed care program and also authorized the Low Income Pool.

With section 1332 waiver authority, Levine said, Florida should develop a delivery model that would replicate a commercial insurance product. The state could provide a subsidy for the coverage, which could also be tiered. He said he would use “choice counselors” created under the pilot program he launched under Jeb Bush in 2005 to help people pick their plans.

“I’ve always been a proponent of combining all the federal flows of money, and wrapping them into a new state-designed model. Imagine …. designing a system that covers the poor in the lowest cost setting, and aligns the interest of government with the private employers,” Levine said.

While the waiver would allow the state to finance a delivery alternative and sidestep the Obamacare requirements, it would not allow the state to ignore the goals of Obamacare — affordable access to care. Waivers will only be given to sates with programs that would have covered as many people as the Affordable Care Act, had it been implemented.

The waivers aren’t available until 2017 but states can start working on a plan to qualify for the waiver now. If Florida started down this path,” Levine said, ” Perhaps they can buy time on (Low Income Pool).”

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