The proposals are called “waivers” because federal law allows the president to waive some parts of health care law to better serve an individual state’s citizens.
Kemp’s waiver proposals for the ACA insurance marketplace in Georgia were approved by the Trump administration in November and were set to go into effect over the next two years.
For the ACA marketplace, Kemp proposed that when Georgians try to shop for insurance plans on the ACA marketplace website healthcare.gov, they be blocked from shopping there. Instead, he proposed that the site direct shoppers to a list of private insurance agencies or companies where they could shop.
The waiver doesn’t create any new companies: Shoppers can already buy their ACA insurance directly from private agents. But the plan assumes that by canceling healthcare.gov shopping, the private companies that people shop with will improve their outreach and publicity.
The Biden administration took issue with that. “In its application, Georgia neither quantified the size of the expected investment by the private sector nor indicated any specific commitments by the private sector to engage in outreach and marketing,” the letter said.
ACA waivers by law must stay within certain “guardrails,” including that they won’t harm coverage and won’t increase the federal deficit. The data that the letter asked Georgia to provide could show whether the waiver would still meet those guardrails, given the recent changes.
That data includes information on the age, income and health insurance status of the relevant state population, along with an explanation of the key assumptions the state used to develop estimates of the effect of the Georgia access model.
The Georgia ACA waiver is already the subject of a federal lawsuit.
Kemp’s ACA waiver also has a less controversial provision called “reinsurance,” a state subsidy to insurance companies that could lower premium costs, especially for higher-income policyholders. The Biden administration left that provision alone. Policyholders are expected to see those lower prices in November 2022, as they begin shopping for 2023 plans.