Obamacare permits states to seek a waiver of the Act’s requirements if the state can show that it will increase health insurance coverage and affordability. In 2012, the Department of Health and Human Services and the Department of the Treasury promulgated regulations implementing the state-waiver provision, which were sent to Congress. But three years later, the agencies issued a guidance document that ratcheted up the standards for state waivers. For example, under the regulations, a state could get a waiver by showing that it will increase insurance coverage and lower costs. However, the guidance makes waivers contingent on agency determinations whether the waiver benefits whatever group of state residents the agencies favor. Under these standards, fewer states, if any, will be able to successfully seek a waiver, sticking residents with excessively expensive insurance. The guidance document was never sent to Congress, as required by the CRA, and thus is not in effect, should not be enforced, and could be disapproved by Congress.
The rule is here: https://www.gpo.gov/fdsys/pkg/FR-2015-12-16/pdf/2015-31563.pdf