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Georgia Plan to Drop Obamacare Exchange to Get Federal Approval

Oct. 15, 2020, 8:24 PM

Georgia consumers wanting to enroll in Obamacare will have to buy coverage directly from insurers or through web brokers with the expected approval of a state plan to walk away from the federal HealthCare.gov exchange.

The Centers for Medicare & Medicaid Services “completed its review of Georgia’s 1332 waiver request and is working with the state and federal partners to finalize the terms and conditions for approval,” the agency said Thursday in a statement.

The Georgia Access Plan, once approved, will be the most far-reaching departure yet from President Barack Obama’s signature health-care law.

The plan is likely to face legal challenges based on analyst estimates that it would leave thousands uninsured. As many as 100,000 people could lose coverage in the first year of the new Access Plan, according to a Brookings Institution analysis.

“People will not know where to go,” Tara Straw, a senior policy analyst at the Center on Budget and Policy Priorities, said. “And there are a lot of wrong doors that people will be faced with.”

In 2020, nearly 464,000 state residents selected an Obamacare plan through the federal HealthCare.gov exchange, and another 38,000 enrolled in Medicaid via the exchange, according to the CBPP.

Georgia said in its application that enrollment would increase by 25,000 in the individual market “through improved customer service, outreach, and education provided by the private market.”

About 35,000 Georgians left Obamacare from 2017 to 2019, 92% of whom weren’t eligible for Affordable Care Act premium subsidies, the application said.

Comparing Plans

Georgia has one of the highest uninsurance rates in the country, at 14.8% or 1.4 million people, Gov. Brian Kemp (R) said at a press conference Thursday. Insurance rates have outpaced wages, and enrollment in HealthCare.gov has dropped 22% since 2016, with nearly 130,000 people leaving the marketplace, he said.

“HealthCare.gov has fundamentally failed Georgians. More than 715,000 individuals are eligible for a subsidized plan today, but choose to go uninsured,” Kemp said.

But Straw said that the new state plan could make it difficult for Georgians to compare and pick the best form of coverage.

Web brokers certified by the CMS are required to present all available health insurance options, “but not on the same terms,” she said.

For plans that don’t pay commissions to the brokers, “they can just state the name of the plan and not give any information,” including premiums, Straw said. “That really doesn’t allow consumers to compare plans.”

She added that “brokers have no obligation to enroll people in Medicaid, so those people might face another closed door.”

About a thousand comments were filed with the CMS on the Georgia plan, many of which opposed dropping HealthCare.gov.

Medicaid Expansion

The CMS also announced Thursday that it approved a separate Georgia plan that expands Medicaid eligibility to include adults up to 100% of the federal poverty level. That’s a significant increase over the state’s current 35% threshold, but it stops short of the full expansion to 138% as called for under the ACA.

That departure from the ACA template means the federal government will pick up just 67% of the cost of Georgia’s expansion population, rather than 90%, which is the match rate provided for states that carry out a full Medicaid expansion.

Georgia’s expansion population will also face relatively stiff work requirements to maintain Medicaid eligibility, another departure from the ACA that has faced skepticism in the courts.

The Georgia Medicaid expansion plan requires enrollees to spend 80 hours per month working or carrying out other community-engagement activities, such as job training or job-readiness activities, volunteering, or going to school.

The plan targets around 400,000 uninsured adults of working age under the poverty line, but state officials expect the expansion population to reach just 50,000 over a five-year period.

To contact the reporters on this story: Sara Hansard in Washington at shansard@bloomberglaw.com; Christopher Brown in St. Louis at ChrisBrown@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloombergindustry.com; Alexis Kramer at akramer@bloomberglaw.com