“Obviously we haven’t had a chance to go through and debunk all of the inaccuracies in there,” said Ryan Loke, Kemp’s adviser on health care. “The federal government is still reviewing Georgia’s novel waiver approaches, not some California-based think tank.” (The Brookings Institution produced its report through an initiative with the University of Southern California.)
Georgia currently has nearly the highest rate of uninsured people of any state, tied with Oklahoma for second-worst, according to the Kaiser Family Foundation.
About 460,000 Georgians have signed up for insurance plans under the Affordable Care Act, most of them through the federal exchange. The healthcare.gov website allows people to shop and compare insurance plans, knowing the price they’ll actually be charged after federal subsidies are added for their income level. All the insurance plans available to them and the final premiums for each are presented at once so shoppers can compare.
Kemp’s proposal asks the federal government to waive the ACA requirement that Georgia participate in that website or create its own exchange website. Instead, Georgians would be diverted to contact information for private insurance agents and brokers, health insurance carriers and online broker websites that offer plans.
Kemp’s proposal contends that the change would give Georgians a wider range of health insurance choices. Those who don’t want robust insurance plans could buy skimpier plans. They wouldn’t get subsidized, but with low enough coverage the plans might be cheaper even so. The Kemp administration estimates that the plan would add 25,000 Georgians to the insured rolls.
The problem with that logic, the critics say, is that people already have access to those options. They can even find private brokers and agents by going on healthcare.gov and searching for their zip code. If they can’t go to healthcare.gov at all, the critics say, some people may instead give up on health insurance.
And those that ended up signing up themselves or their children for Medicaid through healthcare.gov may well not have that option with an insurance agent. Brookings says 38,000 Georgians signed up for Medicaid on healthcare.gov on their own last year.
“The conclusion that the waiver reduces coverage is fairly obvious,” said Christen Linke Young, a fellow with the Brookings Institution. “The state is taking away the enrollment option that is used by thousands of consumers in the state and not giving consumers anything new.”
The Brookings analysts are also concerned about the type of coverage that private brokers and websites offer, or encourage. They can be offered larger commissions or profits for selling plans with skimpier coverage and plans that may not be insurance at all.
“The conclusion that the waiver reduces coverage is fairly obvious. The state is taking away the enrollment option that is used by thousands of consumers in the state and not giving consumers anything new."
- Christen Linke Young, a fellow with the Brookings Institution
Psychiatric coverage is a particular concern to critics. The advocacy group Georgians for a Healthy Future, which supports the exchange, said the plan leaves those with mental or behavioral health issues “exposed and in danger” at a time when the pandemic and opioid abuse are increasing the need for coverage.
“Insurers and web-brokers, who would be in charge of helping Georgians find health insurance, have developed a track record of steering consumers toward substandard plans that expose them to catastrophic costs if they get sick...most substandard plans do not cover mental health services, and many do not offer substance use or prescription drug benefits,” the group said.
A representative for independent insurance agents’ advocacy group in Georgia did not provide comment about the issue.
The waiver proposal has another major initiative, which is intended to lower premium costs across the board. It is much less controversial, having been tried in other states. It is called “reinsurance” and would create a state subsidy to pay off some of the larger claims of ACA policyholders. By subsidizing insurance companies’ claims costs, the hope is that subsidy will trickle down to lower premium costs for all policyholders.
The state estimates the cost of that at $398 million in the first year. Part of that would be self-funding, since the government no longer has to subsidize some plans. Part would come from Georgia state tax money.
It is unclear whether those would be the sole sources of funding: The waiver’s summary lists only those. But the more detailed descriptions elsewhere in the waiver application say that money that currently goes to pay for the federal exchange would instead go to the reinsurance program.
The Trump administration is accepting public comment on the waiver proposal until Sept. 16. The waiver information can be found under “Georgia” at this website, and comments can be mailed to email@example.com