Under plans greenlighted Thursday by the Trump administration, thousands of Georgia’s poor and uninsured adults who meet a work or activity requirement will soon be eligible for Medicaid, with perhaps 50,000 added to the rolls within two years — if the plans pass legal muster.
Within three years, hundreds of thousands of Georgians with individual health insurance plans may see noticeable drops in their premiums: 25% or more for higher-income rural residents, perhaps 4% for Atlantans.
At the same time, the 400,000 Georgians who bought individual health insurance plans on the federal healthcare.gov Affordable Care Act shopping website will find they can’t do that anymore. Instead they will be directed to contact information for private brokers or insurance companies.
And more than 350,000 very poor, uninsured Georgia adults still won’t meet Georgia’s requirements for Medicaid, according to estimates by the office of Gov. Brian Kemp, who devised the plans.
On Thursday afternoon, Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services, joined Kemp and his supporters at the Georgia Capitol to sign her approval to his landmark proposals to reshape Medicaid in the state, and announce that his proposal to reshape the private insurance market would also be approved.
The plans are now ready to roll, unless people sue and the courts intervene.
“The status quo is simply unacceptable,” Kemp said, citing the state’s high premium costs, paltry number of insurance options, and high level of uninsured people—second-worst in the nation.
“This opportunity will help hardworking Georgians climb the ladder, while having a health care safety net below them," he said. "We are making insurance accessible for those who need it the most.”
Kemp’s office says the proposals aim to create a pathway along several steps—for those who qualify—from being unemployed and uninsured, to eventually having insurance and being engaged in the community.
Verma echoed that mission.
“Georgia just isn’t handing out Medicaid cards,” she said. “They’re trying to improve the health of these individuals. To give them the dignity of a job. A pathway out of poverty, and the financial independence that every American seeks.”
Georgia Medicaid now mostly covers children, and some adults, such as those who’ve been declared disabled by the government. Under the new plan, other working-aged Georgians could apply but would have to meet requirements the state would impose. That might include working at a registered employer for 80 hours a month, or attending college full time.
People who don’t qualify would include those whose work was unofficial, such as caring full-time for an elderly relative. Also excluded would be disabled people who aren’t declared disabled by the government, for example a mentally ill homeless person who isn’t approved or doesn’t complete the process.
Controversy
The limited plans quickly drew fire, and threats of a legal challenge.
Advocacy groups and Democrats responded Thursday with a call instead for full Medicaid expansion to all the state’s very poor, as envisioned by the Affordable Care Act and done by 39 states.
They said that the requirements to report work or acceptable activity hours would put up barriers to the people who need help most. Democrat Stacy Abrams' group also launched TV ads the same day, calling to “heal” Georgia by ousting politicians who oppose full Medicaid expansion.
“Georgia needs Medicaid expansion now,” the ads say. “But Governor Kemp and the Republican leadership have done nothing but roll back our healing process.”
There are upsides to full expansion. In addition to broader coverage and less red tape, under the Affordable Care Act if a state fully expands Medicaid, the federal government would pay $9 to every $1 the state put in.
The downside is it still costs more. In Georgia, GOP leaders have argued it would be too expensive. A fiscal note prepared for the Legislature last year estimated it would cost the state about $200 million annually.
The controversy is not just political but also legal.
A group that successfully sued states over work requirements they imposed after expanding Medicaid is now looking at Georgia.
Federal courts have held that work requirements don’t advance Congress’s objective with Medicaid, which was to cover people with health insurance. Kemp’s office says it’s not imposing a work requirement, but a qualification, and the timing of his proposals makes all the difference.
The National Health Law Program disagrees.
Leonardo Cuello, the group’s director of health policy, stressed that it was still reviewing the proposal. However, he said, if both the Medicaid and the private insurance policies are approved, “then both of them are an abuse of authority" given by Congress.
Private insurance
One proposal that is not legally controversial is Kemp’s “reinsurance” plan to lower premium prices for those who buy individual insurance.
Kemp plans to pour public money into the private insurance market, a move that is likely to reduce premium prices for people who shop for individual health care plans but who make too much money to get much help from the current federal subsidies.
The state and federal governments would pay insurance companies for some of the more expensive claims they face, subsidizing them by about $399 million a year. Much of that would come back in savings from subsidies to premiums, but perhaps $93 million would have to come from the state’s general fund.
Kemp also plans to block access in the state to the federal healthcare.gov website, where about 400,000 Georgians buy their individual insurance plans, contending it’s too cumbersome.
Diverting Georgians to private brokers, he argues, he will increase the range of plans they are able to see.
Critics contend that’s the problem, since some brokers and insurance companies have a track record of profiting by selling consumers plans that provide inadequate coverage.
Healthcare.gov, in contrast, only offers plans that meet ACA requirements for covering benefits such as prescriptions and psychiatric care.
Critics estimate that after the federal website is blocked, perhaps 60,000 more Georgians would be uninsured. However, Kemp’s aides say it would expand coverage by about 25,000.
Staff writer Greg Bluestein contributed to this report.
MORE DETAILS
For 10 years, Georgia has grappled with whether to expand Medicaid to the state’s uninsured poor adults under the Affordable Care Act. On Thursday, the state made its first move, winning approval to insure some, but not all. Other plans: to block the healthcare.gov insurance website and to lower premiums for some policyholders.
HOW THE WAIVERS WORK
Here’s how the waivers will affect health insurance in Georgia.
The Healthcare.gov website:
Georgians will be blocked from using the federal website where they now can shop for insurance plans. The state would not build its own replacement website but instead refer people to insurance agents and brokers to find insurance.
Medicaid:
About 50,000 uninsured, very poor Georgia adults could receive Medicaid coverage if they meet work requirements or perform activities such as attending college full time. Medicaid would not be extended to the other 358,000 very low-income, working-age adults.
Reinsurance:
Georgia will use money from the state general fund to subsidize insurance companies' costs for some of the more expensive claims. That “reinsurance” should lower premium prices for those who make too much money to qualify for any significant subsidy under the Affordable Care Act.
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