State Revises Insurance Waiver Request And Pushes Timetable Back

The waiver plan still aims to replace the state’s current website procedure with what officials call a new, consumer-friendly enrollment process.

Alex Brandon / Associated Press

Georgia has streamlined its proposal to the feds for a waiver on health insurance rules and has postponed its launch till 2022.

State officials cited “the unanticipated impact of COVID-19 on the state and its residents’’ in the announcement last week about the changes.

The pandemic has required a “prioritization of resources” dedicated to responding to the emergency that would otherwise contribute to finalizing and implementing the waiver for a January 2021 launch, state officials told GHN on Monday.

Gov. Brian Kemp’s administration submitted the original waiver plan for federal approval in December.

The state plan, as revised, still features reinsurance. That’s an effort to stabilize health insurance premiums by capping the cost that insurers incur in covering people with high medical costs. Several states have adopted reinsurance, which officials say has brought down the price of premiums for individuals and families buying coverage on the Affordable Care Act insurance exchange.

The Georgia reinsurance program would seek to reduce premiums for consumers by an estimated average of 10 percent.

The waiver plan still aims to replace the state’s current website procedure with what officials call a new, consumer-friendly enrollment process.

But the modified proposal drops the idea for state management of the subsidies offered to consumers in the health insurance exchange. The exchange was created by the ACA for people who don’t have employer-based or government health insurance.

And unlike with the previous proposal, Georgia will no longer seek to offer health plans that may not have the comprehensive benefits required by the ACA — and allow federal subsidies for that coverage. A provision that could limit financial help for consumers is gone, too.

State officials said Monday that health plans without the ACA benefit rules can still be offered and that Georgia can choose to provide a state subsidy.

A public hearing on the Section 1332 waiver was held Monday.

“The delay of Georgia’s proposed reinsurance program is a disappointment for Georgia consumers who are looking forward to premium relief,’’ said Laura Colbert of the consumer advocacy group Georgians for a Healthy Future.

“However, the other changes made to the governor’s plan will reduce the harmful impacts that consumers would have felt under the original proposal,” she said. “While we still have concerns about the transition from an unbiased, neutral enrollment platform like to for-profit, decentralized insurers and web brokers, we are encouraged by the move to preserve the financial help and comprehensive health coverage provided to consumers by the Affordable Care Act.”

Georgia officials, under the waiver, will manage eligibility for the subsidies or discounts and calculate that amount for individuals. 

The state, in its announcement, did not mention the other waiver plan submitted by the governor: a Section 1115 request on adding uninsured adults to the state Medicaid rolls, provided they meet strict eligibility criteria.

How much will change?

A state must demonstrate that its new plan compares with the current system in the following ways:

– Provides coverage that is at least as comprehensive in covered benefits

– Provides coverage that is at least as affordable (taking into account premiums and cost-sharing)

– Provides coverage to at least a comparable number of state residents

– Does not increase the federal deficit

Bill Custer, a health insurance expert at Georgia State University, said the feds may scrutinize Georgia’s assumptions about enrollment if changes are put into effect.

“If the waiver is going to be cost-neutral or cost-reducing, the savings in federal subsidies from reduced premiums can’t be swamped by increases in subsidies because of more people enrolling.‘’

Custer also said that “it is difficult for me to see how moving enrollment from to brokers and insurers will save any money or increase enrollment.’’

Blake Fulenwider, chief health policy officer for the Georgia Department of Community Health, said Monday that the Georgia waiver plan would allow consumers to enroll directly with insurers.

He added that the new state-run enrollment would streamline referrals of individuals and families to the state Medicaid program.