Georgians who currently shop for health insurance under the Affordable Care Act using the federal website healthcare.gov could soon be offered a new state-run shopping website instead.
Gov. Brian Kemp on Tuesday signed into law the state’s website, but approval is still needed from the Biden administration. If the new plan gets federal approval, almost 900,000 Georgians who rely on ACA insurance will still be able to continue to comparison shop among the plans as they’ve done in the past. The change will be that the central shopping website will be designed and operated by the state.
Kemp’s move to create a state-run shopping website marks a change for the governor, who had previously advanced a plan to block Georgians from shopping for health plans on healthcare.gov without any new alternative that would have allowed them to compare plans.
The move also marks a major reversal for Georgia GOP leaders from a decade ago. At that time, Republicans in the state so strongly opposed the Affordable Care Act that they voted to make it illegal for Georgia to help people sign up by creating a state-based shopping website for it. Senate Bill 65, which Kemp signed Tuesday, strips away that ban.
More than 879,000 Georgians have signed up for current ACA insurance coverage plans. The majority use healthcare.gov to sign up. Others sign up directly on insurance company websites, or through middleman websites like healthsherpa.com.
The federal website healthcare.gov lets shoppers compare health insurance options in one place. Shoppers input some personal information, then see the different policies they qualify for and prices for each, with federal subsidies calculated in.
Under an earlier proposal Kemp made in 2019, the state wanted to block Georgian’s access to healthcare.gov, instead sending them to third-party sites for ACA plans, including insurance companies’ websites, private agents or other, already existing sites. That proposal was approved by the Trump administration, but later suspended by the Biden administration.
A spokesman for Kemp, Garrison Douglas, said in an email Monday that the governor’s change in approach was not so much “a shift in strategy, but rather an expansion” of the governor’s plans. Douglas still alluded to the Affordable Care Act as “a one-size-fits all, broken government program.”
Eighteen states run a state-based exchange as Georgia is proposing to do. The majority are left-leaning states supportive of the ACA from the time of its passage. In those states, the ACA shopping website is tailored to each state’s residents in ways that are supposed to make shopping easier. Those states also get funding to run their sites that the federal government otherwise would take to run healthcare.gov.
If approved by the Biden administration, the Kemp administration wants to make the shift this year, enrolling people in plans this fall for coverage that would start Jan. 1.
That imminent timeline has become a point of contention, according to documents and correspondence between the state and federal governments.
Given the time that it takes to properly construct a shopping portal for hundreds of thousands of people for something as complicated as health insurance, federal rules require that states spend at least 15 months putting one together.
Georgia hasn’t spent anywhere near that much time specifically on the new version of its proposal. However, Georgia is arguing to the feds that the time it spent working on the previous version of the proposal should also count, since many of the website requirements were the same.
The U.S. Centers for Medicare and Medicaid Services will make the determination.
A history of opposition
Consumer advocates are wary.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
“Ideally, a state-based marketplace will allow for a more tailored experience for consumers and allow the state to innovate,” said Laura Colbert, executive director of Georgians for a Healthy Future, which supports the ACA. “I have some concerns about whether the state has the vision for that.”
Colbert said the work on the new marketplace comes as the state is simultaneously working on two other health priorities. The state is preparing a first-of-its-kind limited Medicaid expansion; and Georgia, along with other states, has also just begun a post-pandemic re-evaluation of all 1.3 million Medicaid enrollees, thousands of whom are expected to be dropped from Medicaid and will need to enroll in ACA plans.
Kemp aides confirmed Tuesday that barring federal roadblocks, they intend to go live July 1 with the Medicaid expansion, which they estimate would enroll perhaps 90,000 new Medicaid members. The program requires implementing new work and engagement eligibility requirements and training state workers to screen for them.
Justin Giovanelli, an associate research professor on health insurance law at Georgetown University, also raised concerns about bandwidth.
“It seems a particularly poorly timed decision to change the enrollment platform and the process so dramatically,” Giovanelli said, “at a time where you’re likely to have such an influx of new folks who are trying to understand their options, trying to to land in coverage that’s going to work for them.”
On Tuesday, Kemp told a reporter for The Atlanta Journal-Constitution that his administration was not taking on too much, and that all its initiatives were on track to work well.
“We’ve got a great team,” Kemp said. “That’s why we’re here. We’ve got a lot of work to do.”
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