Georgia’s proposal to walk away from the federal HealthCare.gov insurance exchange would leave as many as 100,000 people in the state going without coverage, analysts who support Obamacare say.
The Peach State’s plan would have consumers buy coverage directly from insurers or through web brokers. It recently picked up steam with the federal Centers for Medicare & Medicaid Services saying the state’s application can move forward. The CMS scheduled a fast public comment period ending Sept. 16 with a final decision due within 180 days.
Forgoing the use of an exchange that allows consumers to compare and buy plans would be a significant departure from how the Affordable Care Act has been implemented, and critics say it would drive down enrollment.
More than 450,000 Georgia residents selected plans through HealthCare.gov in 2019, the state said in its application for a waiver from the ACA. A Brookings Institution analysis estimates that 35,000 to 100,000 people would lose coverage in the first year of the waiver.
“If it gets approved, it will definitely be challenged,” Katie Keith, a principal at health-care policy advisory firm Keith Policy Solutions LLC, said in an interview.
ACA followers were surprised the agency deemed the application “complete,” but the administration has consistently maneuvered to give states more flexibility in administering the law, including encouraging states to promote cheaper plans that don’t meet ACA requirements.
The state’s plan, called the Georgia Access Model, would be in effect from 2022 through 2026.
Gov. Brian Kemp (R) revised an earlier, more far-reaching plan that would have capped the amount of subsidies available to state residents for ACA plans as well as sell lower-value, cheaper plans.
The proposal now only would have consumers go directly to insurers or web brokers rather than use HealthCare.gov, with the state determining eligibility to enroll in ACA plans and receive premium subsidies.
Web brokers who meet federal qualifications are already allowed to enroll people in ACA coverage, Christen Linke Young, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy, said in an interview.
Georgia’s plan wouldn’t meet the requirements of the ACA because it would result in fewer people being covered than would be covered through HealthCare.gov, Young said.
“When you remove an existing enrollment channel without replacing it with anything, that’s going to mean fewer people enroll in coverage,” Young said.
State innovation waivers, the type of waiver Georgia is applying for, are supposed to be used “to allow states to experiment with more comprehensive protection, to go further than the Affordable Care Act in expanding access to coverage,” Keith said.
“You would really just be pulling out one piece of the ACA that is so important to folks, which is the single one-stop-shop marketplace, and not replacing it with anything,” Keith said.
The Georgia plan also could make it harder for people to get access to Medicaid, Tara Straw, a senior policy analyst with the Center on Budget and Policy Priorities, said in an interview.
About 38,000 people enroll in the Medicaid health-care program for the poor in Georgia through HealthCare.gov, she said.
“If you don’t have that central website where people can go and find out if they’re eligible, they may never get to Medicaid,” Straw said. Brokers typically don’t help people enroll in Medicaid, she said.
The State’s View
However, Georgia counters that more people would have coverage, not fewer.
The state’s application estimates enrollment will increase by 25,000 people into the individual market “through improved customer service, outreach, and education provided by the private market.”
About 35,000 Georgians left the marketplace from 2017 to 2019, 92% of whom weren’t eligible for ACA premium subsidies, the application said.
“The implementation of Georgia Access is expected to attract customers back into the market,” it said.
The state is trying to use the private sector “that is best positioned to help consumers shop for and enroll in a health plan that best meets their needs and budget,” Fiona Roberts, press secretary for the Georgia Department of Community Health, said in an email.
“Today, there is one place Georgians can go to select a plan and receive a federal subsidy. Under the ‘Georgia Access’ model, there will be multiple avenues for consumers to select a plan and maintain eligibility for federal subsidies,” Roberts said.
“The assertion that this plan would, '…cause tens of thousands of Georgians to lose coverage,’ is not supported by what is reflected in actual enrollment, as evidenced by a 15% decline in enrollment through the Federal Exchange since the Affordable Care Act was implemented,” she said.
The Association of Web-Based Health Insurance Brokers said in a statement that “In the Georgia model, web-brokers would have a primary role and would therefore having a significant incentive to invest heavily in outreach and communication to compete for market share and expand consumer coverage.”
The group also said it “strongly favors automatic reenrollment of Georgia consumers in their existing coverage if they do not make an active plan selection as this will help preserve coverage for those transitioning from Healthcare.gov.”