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December 2, 2016

Dear Governors and Commissioners:

As Obamacare continues to saddle patients with less choice, higher costs, and mountains of mandates, it
is clear that major health care reforms must be made to strengthen and improve health care for all
Americans. In the coming months, Congress will begin debating and implementing needed legislation.
Lawmakers, Governors, and state insurance commissioners have a tremendous opportunity to achieve our
shared goal of enacting health care reforms that lower costs, improve quality, empower states and individuals,
and bring our health care system into the 21$1 Century.

Through our efforts to reach consensus on A Better Way for health care, House Republicans gave a lot of
thought to policies that would help put health care spending on a more sustainable path, improve innovation, cut
costs, empower patients, and increase choices. And we need your ideas too. That is why we are seeking input
and recommendations based on your experience overseeing the health insurance markets and Medicaid
programs within your state, for both expansion and non-expansion states. Governors and state insurance
commissioners play an integral role in the health system and will be invaluable partners as we tackle these
important changes together. In fact, we expect that health care of?cials in your state have already begun
deliberative and thorough discussions on what local and unique priorities must be achieved in your upcoming
legislative session. Working together, we are hopeful our joint efforts can help your state make ?scally
sustainable reforms and give all patients a fair shot at quality, affordable health care.

To begin an ongoing and open dialogue, we would appreciate if you and your staff would take time to
provide answers to the following questions:

1. What changes should Congress consider to grant more ?exibility to states to provide insurance options
that expand choices and lower premiums?

2. What legislative and regulatory reforms should Congress and the incoming administration consider to
stabilize your individual, small group, and large group health insurance markets?

3. What are key administrative, regulatory, or legislative changes you believe would help you reduce costs
and improve health outcomes in your Medicaid program, while still delivering high quality care for the
most vulnerable?

4. What can Congress do to preserve employer?sponsored insurance coverage and reduce costs for the

millions of Americans who receive health coverage through theirjobs?

What key long?term reforms would improve affordability for patients?

6. Does your state currently have or plan to enact authority to utilize a Section 1332 Waivers for State
Innovation beginning January 1, 2017?

a. If allowed, would your state utilize a coordinated waiver application process for both 11 15
Medicaid and 1332 State Innovation Waivers for benefit year 2017?

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PRINTED ON RECYCLED PAPER

b. If allowed, would your state utilize a model waiver for expedited review and approval similar to
the Medicare Part transition1 and assistance for Hurricane Katrina evacuees??2

c. If allowed, which requirements would your state seek to waive under a 1332 waiver?

d. If allowed?and if applicable? what changes would be necessary to current guidance to
accelerate your state?s ability to pursue a 1332 waiver?

7. As part of returning more choice, control and access to the states and your constituents, would your state
pursue the establishment of a high-risk pool if federal law were changed to allow one?

8. What timing issues, such as budget deadlines, your legislative calendar, and any consumer notification
and insurance rate and form review requirements, should we consider while making changes?

9. Has your state adopted any of the 2010 federal reforms into state law? If so, which ones? What impact
would repeal have on these state law changes?

Please provide responses by Friday, January 6, 2017. Please submit all written comments to
Along with your submission, please
identify a staffer we can work with to coordinate feedback and meetings.

Additionally, we would be honored if you would join us in Washington early next year to discuss your ideas
and better inform the work of Congress. We will invite the Governor and insurance commissioner of every
state to attend this meeting.

The American people deserve more patient?oriented solutions driven by innovative thinking that takes
into consideration the unique needs of a diverse country. This means more state choices and fewer federal
mandates. Our values, based on the principles of Federalism, drive a philosophy that States should have the
freedom and ?exibility to create options that are best for patients. Insurers should compete for consumer
business and treat patients fairly. And Americans should have access to the best life?saving treatments in the
world. Working as a team, with your help and creative ideas, we can achieve our mutual goal of putting

patients first.
Sincerely,

 
     

 

 

 

Kevin McCarthy Kevin Brady
House Majority Lead Chairman
House Committee on Ways and ans
ed Upton i Kline 
Chairman hairman
House Committee on Energy and Commerce House Committee on Education and
the Workforce

 

1 Centers for Medicare and Medicaid Services. ?State Reimbursement for Medicare Part Transition.? January 24,
2006. 
2 Centers for Medicare and Medicaid Services. ?Disaster Relief for Hurricane Katrina Evacuees in Texas.?
September 15, 2005. 


'Gr alden Virgin' Foxx

Chal - lect Chair- ect

House Committee on Energy and Commerce House Committee on Education and the
Workforce