More than 480,000 Georgians have chosen Obamacare insurance plans for 2017 so far. Open enrollment ends Jan. 31.

Georgia insurance chief asks Congress to allow more local control

Georgia’s insurance commissioner wants Republicans in Congress to allow states more flexibility in setting their own health insurance rules.

Ralph Hudgens, who has long opposed the Affordable Care Act, also says that when it is repealed, as is likely, the federal government should fund state “high-risk’’ insurance pools for people with pre-existing health conditions.

GUIDE: The Affordable Care Act in Georgia

Hudgens made the comments in a Jan. 13 letter to U.S. House Majority Leader Kevin McCarthy, R-Calif., who, along with other House leaders, wrote to governors and insurance commissioners asking for their views on health care changes under the new Congress.

“I welcome any action by the federal government that truly shifts authority away from Washington, D.C., and returns it to Georgia and allows our state to set policy in areas so important to the lives of our citizens,’’ Hudgens wrote.

The Republican-led Congress is poised to pass legislation to repeal Obamacare and develop a replacement plan. Their previous efforts to do so went nowhere, but now they have an ally in the White House. New President Donald Trump has made scrapping the health law a priority.

Hudgens said in his letter that the health care law’s requirement for most people to have insurance or be penalized did not work in resolving the pre-existing condition problem, leading to what he called significant cost increases.

A high-risk pool for high-cost individuals, funded by the feds and run by states, would allow the risk pool for other people “to function normally,” said Hudgens.

Some states have found that high-risk pools had financial difficulties, and some had limitations on coverage.

Prior to Obamacare, Georgia created the legal mechanism for a high-risk pool, but never funded it. High-risk pools were designed to offer health coverage to people with pre-existing conditions that prevented them from getting private insurance. The Affordable Care Act bars insurers from denying people coverage because of a pre-existing condition.

Hudgens also supports insurers selling policies across state lines, even though a Georgia law allowing such sales has not led to any takers.

Georgia Gov. Nathan Deal, like other governors, was among the recipients of the letter from McCarthy and House leaders. Deal spokeswoman Jen Ryan said last week that his staff was reviewing it. Ryan could not be reached Monday on whether Deal had sent his reply.

Deal in the past has called for more state flexibility on Medicaid, which in Georgia covers nearly 2 million people, most of them children.

AJC POLL: Georgians support Medicaid expansion

Deal said in 2014 that he has “often discussed the advantages of a block grant. States need more flexibility in order to make their program work for their unique population rather than a one-size-fits-all Washington mandate.’’

On Sunday, in fact, a top adviser to Trump said the president’s plan to replace the Affordable Care Act will propose a block grant — giving states a fixed amount of federal money to run their Medicaid programs.

A block grant, said Kellyanne Conway, would ensure that “those who are closest to the people in need will be administering’’ Medicaid.

But some health law advocates say that a block grant would disadvantage Georgia, which has a per-beneficiary spending in Medicaid much lower than most states.

“Proposing that block grants give states flexibility really means flexibility to cut services and restrict eligibility,’’ Laura Harker, policy analyst at the Georgia Budget and Policy Institute, said Monday.

The current Medicaid structure allows federal funding to adjust every year based on need, Harker said.

“For example, the amount of federal funds grows during an economic downturn when more people need the program,’’ she said.

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Andy Miller is the CEO and editor of Georgia Health News.