ATLANTA — Georgia’s new health insurance reform plan will address three problems at once, Gov. Brian Kemp announced recently when he rolled out two insurance “waivers” approved by the federal government.
The governor’s “Georgia-centric” approach will reduce one of the nation’s highest uninsured rates, lower premiums and increase competition in the private health-insurance market, Kemp said.
But the plan is getting pushback from patient advocates who argue the state isn’t getting enough bang for its buck and could cover more Georgians for about the same cost to taxpayers.
“This is a huge missed opportunity,” Laura Colbert, executive director of Georgians for a Healthy Future, said. “We’re missing the most cost-effective way to solve this problem.”
The two waivers will allow the state to undertake a limited expansion of its Medicaid program and give Georgians with incomes too high to qualify for Medicaid options outside the Affordable Care Act.
Under the Medicaid waiver, single adults with incomes up to 100% of the federal poverty level, currently $12,760 a year, can enroll in Medicaid or an employer-sponsored insurance plan starting next July. The state will help pay premiums and copays for those who sign up for insurance through their jobs.
To qualify, enrollees will have to take part in “qualifying activities” for at least 80 hours a month, such as a job, on-the-job training, vocational training, education or community service.
Under a second waiver, the state will fund a re-insurance program starting in January 2022 aimed at holding down premiums by paying part of an insurance company’s claims once they exceed a certain amount.
The program is expected to reduce premiums statewide up to 10% on average and up to 25% in some communities, primarily in rural Georgia.
The second waiver also will eliminate the healthcare.gov portal the ACA provides for enrollment in individual coverage plans, effective as of January 2023, and let Georgians sign up directly with private insurance carriers, local brokers or agents, or through web-broker sites.
Georgia enrollment in healthcare.gov has fallen by 22% since 2016, a trend the governor blamed on the site being clunky to use.
“For me, healthcare.gov is a four-letter word,” Kemp said. “The enrollment process has been nothing short of disappointing.”
The state anticipates the Medicaid waiver will cost taxpayers an average of $218 million per year. On the other hand, Deloitte Consulting, the firm the state hired to help develop the waivers, projected the cost of a “full-blown” expansion of Medicaid through the ACA would cost Georgia $547 million annually.
But the plan’s critics question Deloitte’s numbers. They cite a state Department of Audits and Accounts report last year that a full expansion of Medicaid – as 38 other states have done – would cost Georgia $213.2 million in fiscal 2022.
Also, while the state’s Medicaid waiver is expected to cover about 65,000 Georgians, last year’s fiscal note asserted a full expansion – covering single adults with incomes up to 138% of the poverty level – would serve more than 500,000.
“You’re spending four times more per person with this waiver than you would with a [full] Medicaid expansion,” Laura Harker, health policy analyst for the Georgia Budget and Policy Institute, said.
But supporters say there’s more to Georgia’s brand of Medicaid expansion than meets the eye.
Kyle Wingfield, president of the Georgia Public Policy Foundation, asserted in a recent column the Medicaid waiver’s impact will be felt far beyond the projected numbers because it won’t discourage people from bettering themselves by earning more money.
“It will help provide a smoother transition to private insurance markets,” he wrote. “So as people climb the income ladder and move out of the program, new people will enter it – extending the impact to more Georgians.”
Indeed, Kemp predicted more than 270,000 Georgians ultimately will benefit from the Medicaid expansion.
The Georgia waivers’ detractors also are concerned about the qualifying activities the Medicaid waiver will require of enrollees. Colbert said the provision leaves out full-time caregivers and those who don’t have access to the internet, which enrollees will have to use regularly to report their activities.
“The history of Medicaid hasn’t been a program about work,” Harker said. “It’s been a program about health.”
Harker also defended the healthcare.gov website. She said the portal has rebounded from a rash of technical problems when it was first rolled out during the last decade.
But Wingfield argued that replacing healthcare.gov with a wider array of coverage options in the private market would let Georgians buy less expensive coverage if they choose.
“Brokers and insurance carriers will be able to show consumers not only the subsidized, but very expensive, ACA plans, but other types of coverage that may cost them even less out of pocket,” he wrote. “Injecting more competition and options into this marketplace is a crucial step toward reining in prices and giving Georgians better access to care.”