Jason Levitis discusses how federal policies and state-level innovations can shape access to health insurance.
In a conversation with The Regulatory Review, tax and health insurance policy expert Jason Levitis discusses the current state of health insurance policy.
Nearly 15 years ago, the Patient Protection and Affordable Care Act (ACA) broke ground and reshaped the delivery of health care in the United States. But the protections the ACA provides for consumers are not absolute—they have changed across presidential administrations and continue to face fierce opposition.
Levitis describes recent strides by federal and state health officials to build upon the ACA’s provisions. State actors, he explains, have the flexibility to innovate in ways that “provide additional protections and support coverage.” Levitis calls attention to resources and platforms available for states looking to lead the charge for “health coverage expansion.” Looking ahead, he anticipates that state-level efforts will be critical to defend access to affordable health care.
Levitis is a senior fellow at the Urban Institute’s Health Policy Center and a nonresident senior fellow at the Solomon Center for Health Law and Policy at Yale Law School. Drawing upon his experiences from practice and research, Levitis provides technical assistance to state health officials through State Health and Value Strategies—a program funded by the Robert Wood Johnson Foundation to help states expand access to health care that is “affordable, equitable, and innovative.”
Before joining the Urban Institute, Levitis served at the U.S. Department of the Treasury between 2009 and 2017, where he led the Treasury Department’s implementation of the ACA and co-chaired a working group that launched the Section 1332 waiver program. His current research lies at the intersection of health care and tax law, focusing on federal and state policies that affect access to private health insurance.
The Regulatory Review is pleased to share the following interview with Jason Levitis.
The Regulatory Review: In recent years, what protections have the federal government added to the ACA to support access to health care insurance coverage on the private market? Do any flexibilities exist at the state level to supplement these protections?
Levitis: There’s a set of things I would describe as protections that support access to health coverage and then a broader set of things that expand access in other ways. On the protection side, examples include making sure people aren’t hurt by non-compliant coverage like short-term plans. And then there are all the things that the Centers for Medicare & Medicaid Services (CMS) has done recently to crack down on broker fraud. More broadly, there have been major strides in supporting access to health coverage through things like the premium tax credit enhancements and fixing the family glitch.
On state flexibility, yes, states have several options to provide additional protections and support coverage. Many states have their own laws that protect consumers from the potential harms of non-compliant coverage. States can also create their own supplemental subsidies that help people afford coverage. And the whole Section 1332 program is aimed at giving states flexibility to support health coverage.
TRR: To that end, could you provide examples of states that have taken innovative measures to address barriers to accessing private coverage?
Levitis: Some of the most exciting state actions are in subsidies to support coverage and in facilitating enrollment into coverage. States can provide support for premiums or cost-sharing for people with Marketplace coverage. And they can also help reduce administrative burdens in enrollment, including smoothing transitions from Medicaid to the Marketplace.
TRR: Where can state officials best find guidance as they shape health insurance policies that expand access to private coverage?
Levitis: I do a lot of work with an organization called State Health and Value Strategies, which is a project funded by the Robert Wood Johnson Foundation and housed at Princeton University. Our charge is providing technical assistance to state officials to help them support health coverage and address structural racism in the health care system. Our team includes several former state and federal officials who really get the needs of states and have technical expertise in navigating the federal regulatory landscape.
TRR: How do you think the current administration’s health care agenda will affect how states will need to structure their policies about health insurance?
Levitis: There’s a lot of uncertainty about how federal policy will play out. But if it’s anything like last time, what we saw was that the federal government was no longer pushing in the direction of supporting health coverage, and states had to step in. That was when a lot of this innovative work on state subsidies and facilitated enrollment was born. So I think there will once again be a huge role for states in leading health coverage expansion.
TRR: What advice would you give law students or new lawyers who are interested in pursuing a successful career in health care or insurance law?
Levitis: The first piece of advice is that it’s a great area of law to practice for a lot of reasons. It’s incredibly important to people’s well-being. It’s a huge part of the economy. Depending on where you work, it can come with more reasonable work hours than some other areas of law. And there’s a huge amount of rich and fascinating law to dig into.
Health care and health insurance are also massive fields, and one can quickly become a leading expert in a subspecialty just by reading all the laws, regulations, and forms. So it’s an area where one can quickly contribute.
