Decade in, Georgia ACA signups reach record high

Deadline to sign up for the Affordable Care Act’s health insurance coverage for 2023 is Jan. 15

As the Affordable Care Act’s health insurance marketplace enters its 10th year, rocketing numbers of Georgians are using it to get insured. With open enrollment for 2023 coverage ending Sunday, Jan. 15, a record of more than 846,000 Georgians have already enrolled.

The marketplace’s popularity is driven partly by rising federal subsidies for those with higher incomes, advertising and enrollment assistance. The federal program originally known as Obamacare, once came close to repeal but now accounts for an important fraction of Georgia’s insurance market.

The numbers enrolled for 2023 are still being counted, but could reach 1 million insured Georgians by the time open enrolment closes Sunday at midnight. If it does, approximately 1/10th of the state’s population would be obtaining insurance through the marketplace.

In 2021, the last year for which a breakdown is available, Georgia’s 10.5 million residents got health insurance most often through their employers, but also through the ACA marketplace. Another 227,000 were insured through the military, 1.3 million had Medicare and 1.8 million, mostly children, had Medicaid. About 1.3 million had no insurance.

“It’s been life changing for people,” said Kirk Lyman-Barner, an insurance agent who sells large numbers of ACA plans at an agency in Sumter County.

Cherisse Fletcher, 49, signed up for an ACA plan for the first time this year, using Lyman-Barner as her agent. She credits many things that pushed her to buy the coverage: the federal website healthcare.gov for referring her to the right agent when she had trouble enrolling on her own; her son who had heard about healthcare.gov and referred her; and the robust, affordable coverage that is now available through higher federal subsidies.

“It was very easy; it was smooth,” Fletcher said. “It’s been a blessing for me.”

States nationwide are seeing big increases in signups for ACA plans last year and this year. As a large part of the reason, experts credit subsidies that the Biden administration pushed as part of federal pandemic legislation. Those subsidies attacked a major problem with ACA plans: before then, Anyone who made more than 400% of the federal poverty level, or about $111,000 per year for a family of four, had to pay the whopping full price set by the insurance company.

The Biden legislation sets limits on the percent of their income a policyholder has to pay, however.

An annual income of $100,000 per year may seem like a lot of money, “But if you’re paying for a full family’s premium that could be several thousand dollars a month,” said Cynthia Cox, vice president of the Kaiser Family Foundation, a research institute on health care.

The subsidies also helped people near the poverty line, she said, who previously had to pay out of pocket amounts that might seem negligible to middle-class people but could be unaffordable to the lowest income policyholders. “Two percent of their income — that is still something,” Cox said.

In 2022, Georgia’s average monthly premium after subsidies was $98 and some may qualify for free coverage.

The extra subsidies will sunset in 2025 unless Congress renews them.

The Georgia factor

State policies have influence too. In Georgia, that’s been complicated for the ACA.

Republicans across the board opposed the ACA, and Gov. Brian Kemp of Georgia was no different. Kemp has since devised alternate plans.

Kemp worked with the Trump administration to devise a plan that would block Georgians from ever shopping on the federal ACA website, healthcare.gov. Instead, they would be sent to a state website that in turn offers them individual insurance companies’ and other websites. The plan has been halted by the Biden administration but could still go through.

The main difference between the system Kemp wants and what healthcare.gov does, is that the website Kemp wanted to create doesn’t show people plans they can compare.

The state website does include a link to a private website that is supposed to allow people to shop plans, W3ll.com, but a reporter that attempted to use it ran into a glitch and was blocked.

Healthcare.gov’s signal feature is allowing people to contrast and compare plans. A shopper inputs their income, age and a couple other pieces of information, and is shown the different plans they are eligible for, all at once. Many people find healthcare.gov clunky. Agents often instead use healthsherpa.com, a private website that provides an easier interface for the same information.

Credit: Ariel Hart

Credit: Ariel Hart

George Kalogeropoulos, CEO of HealthSherpa, said that enrollment on healthsherpa.com this year just for Georgia has surged from 120,700 signups last year to 215,700 signups for 2023, and the year’s not over.

Still, the Kemp administration is taking credit.

“Any time more Georgians are signing up for health insurance is cause for celebration,” Insurance Commissioner John King said in a written statement. “Thanks to the investment from Governor Kemp and the state legislature, our team created and promoted the GeorgiaAccess.gov website to provide Georgians with information on the health insurance options available to them during this current open enrollment period. What we’re seeing with these record enrollment numbers is a direct result of this investment and I’m proud of the ongoing work of our state to get our citizens covered.”

The Department of Insurance provided no data to support that assertion. The state has spent more than $31 million on that effort.

(UPDATE: After this story was published, the State Insurance Commissioner’s office provided some supporting data to the AJC. See below.)

Update

For 2023 plans, signups for subsidized health insurance under the Affordable Care Act surged in Georgia. Experts say it’s mostly a result of subsidies that led to lower premiums, advertising, and more help and time for people to sign up. The state Office of Insurance has another reason: it established the website GeorgiaAccess.gov, to attract people to insurance agents and companies that would sign people up for plans. The office says it spent $5 million on an advertising campaign to draw ACA shoppers to GeorgiaAccess.gov. Their data show that the campaign’s ads were seen on the internet or other media more than 160 million times. The office did not provide data on the actual web traffic for GeorgiaAccess.gov and how many visitors ended up clicking through and buying a plan.

Experts the AJC interviewed said they saw no evidence that GeorgiaAccess.gov was responsible for the increase in enrollment. But it’s likely another Kemp program did attract policyholders: A “reinsurance” program gives state money to private insurance companies to pay off some of the most expensive insurance claims, which helps lower premiums.

For Fletcher, she’s just glad to have the insurance.

She’s sick with diabetes, sometimes very sick. She always had insurance through her job, but her job required being extremely inactive, which made her diabetes worse. Then her husband got cancer and had to leave his job. There was no way she could take a risk on new work if it meant going without insurance.

Then Fletcher learned she could get insurance through the ACA. She left her unhealthy job, with an eye to taking on part-time work she can do at home. She’s immediately taken on caring for her baby great-grandson too. That allows the baby’s parents, who do manual labor, to both take on more shifts.

Lyman-Barner marvels at how the ACA has helped three generations of one family.

“This one circumstance helps out more than just me, it helps out them also,” Fletcher said.