Washington now in standoff with Kemp on Affordable Care Act waiver plan

Credit: Alyssa Pointer

Credit: Alyssa Pointer

Tensions are near a breaking point between the White House and Gov. Brian Kemp over Kemp’s plan to block Georgians’ access to the Affordable Care Act’s federal health insurance shopping website, healthcare.gov.

In a letter last week, the U.S. Centers for Medicare and Medicaid Services told Kemp health aides that Georgia has until August 29 to answer questions that CMS has raised about the plan. Otherwise, it wrote, Georgia will be in violation of the state-federal partnership that underlies the proposal.

In such a case, the letter said, the feds can re-evaluate the “waiver” proposal without the state’s input. If they find the proposal no longer meets the guidelines to qualify as a waiver, they “will take appropriate action.”

The letter on its face offers Georgia a chance to explain how its waiver still meets federal requirements, said Krutika Amin, associate director for the Kaiser Family Foundation’s program on the ACA. However, she added, “I think the letter essentially signals that CMS does not view any of the evidence as meeting the requirements for the waiver.”

With the July 30 letter, Kemp now is in a standoff with Washington, possibly headed to court, over both of his most sweeping health care initiatives. Earlier this summer, the state had to delay rollout of its limited Medicaid expansion after that waiver request also met with skepticism from the Biden administration.

The waivers — called that because states ask the federal government to waive portions of federal law so states can experiment with ways to tailor programs — were approved in the waning days of the Trump administration.

Kemp’s Medicaid proposal calls for expanding the insurance program to those who meet certain work or other eligibility requirements and has been projected to eventually cover about 50,000 of the state’s 400,000 uninsured low-income adults. The federal match would fund about two-thirds of the cost.

CMS put the waiver on pause, changing its status from approved to pending, and asked the state for an updated economic and actuarial analysis of the plan. Georgia officials said they would challenge any decision by the federal government to rescind approval.

In scrutinizing Georgia’s ACA waiver, CMS’s questions took direct aim at some of the most controversial assertions the Kemp administration made in the course of winning approval.

U.S. Secretary of Health and Human Services Xavier Becerra addressed the questions surrounding Georgia’s waivers, including the Medicaid waiver, in a visit to Atlanta on Monday. Waivers have to meet rules, he told the AJC, such as keeping coverage levels high and not overspending.

“If your model, where you want to have laws waived for you, doesn’t do that,” Becerra said, “then how would we be doing not only the people of Georgia a service, but the taxpayers of America who fund those programs and waivers?”

One reason for shutting down access to shopping on healthcare.gov, Georgia contended, was to increase competition by forcing shoppers off the website and into business with private insurance agents. That way, the state said, the market would improve and more people would be attracted to signing up.

However, critics took aim at that conclusion because the proposal wouldn’t add any new options for shoppers. It would simply take away the most popular option, the website. Instead, shoppers seeking Georgia’s ACA marketplace exchange would see a referral to contact information for individual companies and web brokers.

And on the contrary, they said, private insurance agents have a record of providing worse outcomes for shoppers because of the fees they get from companies for selling particular plans.

CMS has asked Georgia to re-calculate some of its numbers, taking into account such changes as the Biden administration’s restoration of advertising and outreach funding for ACA enrollment, and the increase in enrollment during the pandemic. It has also asked Georgia in effect to show its work, to explain where it came up with its original estimates that the waiver would increase coverage and not cost the federal budget more.

In addition, the state asserted that demand for ACA plans had plummeted, so change was warranted. But critics said that the state had ignored other reasons for that and also cherry-picked its data, for example, limiting it to the initial years when the Georgia market had not found its footing. But, as CMS and Georgia negotiated the original waiver, the market for ACA plans had stabilized. And at the moment when CMS approved the waiver in late 2020, demand was increasing, partly as a result of the pandemic.

Kemp’s press secretary, Mallory Blount, told the AJC that the state had received the CMS letter and it was “currently under review.”

AJC reporter Greg Bluestein contributed to this article.


Nov. 1, 2020: CMS under the Trump administration approves Georgia’s waiver proposal for the Affordable Care Act.

June 3, 2021: CMS under the Biden administration requests more analysis from Georgia in light of the changes to federal law and the Georgia landscape during the time of the pandemic. CMS asks for the analysis by July 3.

July 2, 2021: Georgia tells CMS that the request appears to be reopening the approval process, which is not permitted.

July 30, 2021: CMS gives Georgia until Aug. 29 to comply.