The federal government is considering several waiver ideas in Kemp’s proposals, and could deny or approve them separately. This explains some key provisions on the table.
Kemp proposes to expand Medicaid coverage to some, but not all, of the poorest Georgia adults. The state would impose requirements that approximately 50,000 of the state’s 408,000 uninsured, very poor adults would end up meeting, according to the initial proposal.
People who meet the requirements would include those who work at registered employment or serve at qualified nonprofits at least 80 hours a month, or attend college full time. Currently, working-age adults usually are not covered by Georgia Medicaid, which concentrates mostly on children.
People could not meet the requirements, however, by working unofficially, such as full-time caring for an elderly relative. And disabled people who don’t get declared disabled by the government, such as some mentally ill homeless people, would still not qualify for Medicaid.
President Trump’s administrator of the U.S. Centers for Medicare and Medicaid Services, Seema Verma, oversees waiver approval and is a hearty advocate of work and community engagement requirements. She is scheduled to be at the announcement, as is Georgia’s official overseeing Medicaid.
This is known as the 1115 Waiver, or Georgia Pathways.
The Affordable Care Act: the healthcare.gov website
Kemp’s other waiver proposals concern the Affordable Care Act’s insurance marketplace for individual private health plans.
Kemp’s proposal would block Georgians' use of the marketplace’s healthcare.gov website. Currently, about 400,000 Georgians use healthcare.gov to shop for plans and sign up for private insurance. The website calculates what a person would actually pay after adding in subsidies for their income level. It then presents the available plans all together so the shopper can compare prices and coverage. It also lists agents and brokers in the person’s area that could sell insurance if a person prefers that.
The state would not build its own replacement website for shopping. Instead it would refer people to agents and brokers that already exist.
Critics say this would be illegal and would cause perhaps 60,000 more Georgians to be without insurance. They say for those who do buy, it would place them in the hands of private brokers who often have a track record of promoting skimpier coverage than customers are seeking, because they make more profit that way and customers often don’t understand what they’re buying.
Kemp’s office counters that private industry will work harder to sign up more customers, and expand the range of options that shoppers see. The proposal estimates it will add 25,000 additional Georgians to the insured rolls.
This is known as the 1332 waiver, or Georgia Access.
The Affordable Care Act: “Reinsurance”
The most expensive piece of the Kemp waivers would use public money to subsidize insurance companies' costs with some of the more expensive claims. The hope is that the companies' windfall would trickle down to policyholders and lower premium prices. Experience in other states shows this has worked.
The benefit is felt most by higher-income households.
For the working poor or lower-middle-income households, the ACA’s health insurance subsidies already make plans more affordable, or even free. But subsides shrink as incomes increase. And for people who make more than $51,000 for a single person or $105,000 for a family of four, there are no subsidies at all. They pay the full cost of insurance premiums, which has grown astronomical.
This “reinsurance” plan would lower premium prices by perhaps 10% on average. The biggest savings, perhaps topping 25%, would be in rural areas. Atlantans might see cost reductions of 4%.
Kemp’s office in July estimated the first year’s cost of the reinsurance program would be $399 million. Much of the plan would pay for itself, the proposal maintains, but $93 million would have to come from the state’s general fund.
This is also part of the “1332” waiver.
Kemp originally had a plan to take over Georgia’s $2.7 billion in subsidies and apply them to new types of plans, but he dropped that.