The Centers for Medicare and Medicaid Services on Sunday gave the state permission to stop using the federal exchange, Healthcare.gov, for enrollment in the individual market and shift to a private sector Georgia Access Model, starting in 2023.
State officials argue that the move will give residents access to a broader array of options from web brokers, health insurance companies and agents — which will have a greater incentive to enroll consumers in coverage. They estimate the waiver will lower premiums and increase enrollment by 25,000 people.
Advocates, however, fear that it could shift healthier people to less comprehensive, non-Obamacare plans and leave those with pre-existing conditions facing higher premiums for Affordable Care Act policies. Plus, consumers could unknowingly sign up for skimpier policies.
“Consumer could end up in insurance plans that don’t cover everything they think it would cover,” said Tara Straw, senior policy analyst at the left-leaning Center on Budget and Policy Priorities.
What’s more, the Georgia waiver would eliminate residents’ ability to go to a single website to see all their options. Instead, they would have to navigate a fragmented system of broker and insurers — similar to what existed prior to the landmark health reform law, Straw said. This would likely decrease coverage and raise premiums.
The waiver does not meet the federal requirements for approval, including covering as many people with the same affordable and comprehensive coverage as without the waiver, Straw said. This will open up the approval to legal challenges.
About 433,000 Georgians were enrolled in Obamacare exchange plans, as of February, according to federal data.
The Trump administration is backing a coalition of Republican-led attorneys general, including Georgia’s, who argue that Obamacare’s individual mandate was rendered unconstitutional after Congress reduced the penalty for not having insurance to zero as part of the 2017 tax cut law. As a result, the entire health reform law must fall, they argue.
Georgia also received permission Sunday to implement a reinsurance program, which typically reduces premiums by protecting insurers from high-cost patients. More than a dozen states have received federal approval to do this.