The scope of what can be changed under section 1332, at least in theory, is impressive. While states can’t alter the ACA’s protections for people with pre-existing conditions, or allow insurers to deny coverage or charge higher premiums to consumers with high expected health costs, they can:

• use federal funding for the premium tax credits payable under the ACA to provide subsidies to individuals in a different manner;
• alter the essential health benefit requirements of the ACA;
• change other ACA insurance rules; and
• terminate the ACA exchanges while building new mechanisms for establishing enrollment in health coverage.