Georgia health proposals hang in the balance as Biden official visits

U.S. Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure visited Atlanta on Tuesday.  She is shown here participating in a roundtable meeting on the Affordable Care Act at the Family Health Center of Georgia.  (PHOTO by STEVE SCHAEFER FOR THE ATLANTA JOURNAL-CONSTITUTION)

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U.S. Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure visited Atlanta on Tuesday. She is shown here participating in a roundtable meeting on the Affordable Care Act at the Family Health Center of Georgia. (PHOTO by STEVE SCHAEFER FOR THE ATLANTA JOURNAL-CONSTITUTION)

A top federal official in charge of negotiating with Gov. Brian Kemp on Georgia’s high-stakes health care proposals visited Atlanta for the first time on Tuesday in her job as Centers for Medicare and Medicaid Services administrator. But she had no answers for when any of the half-million adults uninsured under Georgia Medicaid rules might have a pathway for coverage.

Kemp and the official, Chiquita Brooks-LaSure, didn’t even meet. A Kemp spokeswoman said his office wasn’t invited.

It’s been more than a year since the Trump administration stamped a last-minute approval on two of Kemp’s health care “waiver” plans as Trump’s presidential term drew to a close. And it’s been several months since the Biden administration raised concerns and paused the plans.

Meanwhile, half a million Georgians remain uninsured: too poor for subsidized ACA exchange insurance under federal law, and too old to qualify for Medicaid under Georgia rules.

Both sides say they’re still in talks.

“We’re having conversations with Georgia,” Brooks-LaSure said, when pressed on the waivers.

A spokeswoman for Kemp, Katie Byrd, said “the discussions are continuing” with the administration.

In Kemp’s waiver proposal for Medicaid expansion, some but not all poor Georgians would end up being covered. The Biden administration would prefer that Georgia expand Medicaid to all of its poor adults.

Instead, Georgia proposes to expand Medicaid only to those who meet certain activity requirements, including working at a regular job, for 80 hours per month. Activities that would not qualify include off-the-books jobs such as taking care of an elderly relative.

Kemp’s office estimated that more than 400,000 people would not meet the Medicaid requirements and would be left uninsured. Kemp and the Trump administration argued that the proposal would improve people’s lives by valuing work. The Biden administration argues that it adds unnecessary barriers to coverage.

“I think we’ve made very clear our concern, particularly during this COVID-19 pandemic, one that we haven’t seen in generations, how concerned we are around work requirements,” Brooks-LaSure said.

The Biden administration has not approved any state’s proposed work requirements. Courts have struck down previous attempts at work requirements, calling them inconsistent with Medicaid’s objective of providing health coverage.

A bill that Democrats support in Congress, the Build Back Better Act, as currently written would provide a work-around for the federal government to expand Medicaid itself, to all poor adults. That bill has not yet passed the Senate.

In the other waiver proposal, for the Affordable Care Act’s marketplace exchange, Kemp would block Georgians’ access to shopping on the main federal website, healthcare.gov. That’s where the majority of the state’s half-million ACA policyholders currently buy their plans.

Instead, Georgia’s proposal would direct those consumers to deal with the insurance companies directly or with private insurance agents to find plans. The waiver proposal would also make other changes.

The Biden administration is reeling that proposal back, and has requested new public comment from Georgians, who can submit comments until January 9.

Brooks-LaSure spent Tuesday morning with patients and health care providers concerned with maternal mortality and African-American maternal health. Georgia has one of the developed world’s worst rates of women dying for reasons related to pregnancy, and those rates are about three times higher for Black women.

Brooks-LaSure was scheduled to end her day at an event with “navigators” who help consumers buy health insurance on the Affordable Care Act exchange marketplace. The Biden administration restored funding for navigators and other resources to support ACA enrollment. Georgia’s marketplace is booming, with 11 companies offering insurance plans on the exchange, and prices slipping.


HOW TO COMMENT

The federal government is requesting new public comment until January 9, 2022 on Georgia’s proposal to change how the Affordable Care Act marketplace works in the state. These are the feds’ instructions for commenting.

  • Submit comments to stateinnovationwaivers@cms.hhs.gov and include “Georgia Access Model section 1332 waiver comments” in the subject heading. include your name, organization (if any), and email address with the comments.