A little-known provision of the Affordable Care Act (ACA) could significantly affect how the law is implemented in the future.

Starting in 2017, Section 1332 of the ACA allows the federal government to give states waivers granting them considerable flexibility to modify how coverage is provided to uninsured populations. Depending on how the provision is implemented, these authorities could give both conservatives and liberals the opportunity to realize their varied visions of the law’s future.

Among the changes to the law that states could conceivably pursue are the following:

• Doing away with a state’s health-insurance marketplace, the mechanism through which the law makes subsidized private insurance available to eligible consumers.
• Repealing the individual and employer mandates, widely opposed by conservatives, which now require individuals and employers to purchase insurance or face economic penalties;
• Establishing a single-payer health system, like the recently failed Vermont initiative.

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Jeffrey R. Ungvary President