The number of people without health insurance In Washington has dropped from 14.5 percent in 2012 to 7.3 percent in 2015. Though the effects of the Affordable Care Act are evident, about 500,000 people in the state still face barriers to gaining coverage.

In an effort to expand health care coverage to all Washington residents, a coalition of advocacy organizations enlisted the help of researchers from the University of Washington School of Public Health. The researchers—a group of graduate students enrolled in a Public Health Leadership, Planning and Advocacy Skills course—analyzed a federal waiver procedure as a potential avenue for health care innovation and reform.

The waiver, named for section 1332 of the ACA, will offer several opportunities to improve quality and extent of coverage when it becomes effective in 2017, the researchers found. It gives “broad leeway to waive key provisions of the ACA and develop alternative frameworks for providing health insurance,” according to a report prepared by the researchers and presented to the Health Care is a Human Right coalition in June.

The report outlines opportunities and challenges to improving the accessibility and affordability of health care by implementing the 1332 waiver. The report also presents other states’ strategies for expanding coverage.

“The coalition was interested in good research on what other states were doing regarding the 1332 waiver, federal rules and guidance, and how the waiver related to other health care reform efforts,” says Aaron Katz, principal lecturer of health services and adjunct principal lecturer of global health at the School. “The analysis and report are a testament to our MPH students’ ingenuity, hard work and drive to learn and make a difference in the lives of people and their communities.”

The researchers suggest targeted fixes for certain excluded and vulnerable populations, such as undocumented immigrants. The state can provide a non-qualified health plan through the exchange or state subsidies to family members who cannot afford insurance, the report notes.

The state can also use the waiver to introduce more sweeping reforms, the researchers conclude, such as establishing a state-run basic health program to provide more affordable coverage to those severely below the federal poverty level.

“The success of any 1332 waiver proposal will depend heavily on politics at both the state and federal levels,” the report says. Funding and the potential effect on premiums are also noted as challenges.

To learn about the priorities for the waiver and to determine what would be possible in Washington, the researchers conducted a series of in-depth interviews with local, state and national informants. Among them were experts in insurance, law, policy and advocacy.

“The students went from zero knowledge about the topic to a pretty sophisticated analysis of options for how the state might use the 1332 waiver opportunity,” says Katz, who teaches the policy and advocacy module for the course alongside Samantha Hatzenbeler, clinical instructor of health services and alumna of the School’s Community-Oriented Public Health Practice program. ”And they did so in only five weeks.”

Participating students were Tianna Fallgatter, Zachary Liao, Kaitlyn Kennedy, Karren Lewis and Toral Parikh.